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University of Washington

Health Care Alternative Spring Break 2007

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Table of Contents Letter from Health Care Alternative Spring Break ........................................................... 3

About Health Care Alternative Spring Break ................................................................... 4

Benton & Prosser Pictures and Reflections..................................................................... 5

Brewster Pictures and Reflections .................................................................................. 8

Colfax Pictures and Reflections .................................................................................... 11

Davenport Pictures and Reflections .............................................................................. 13

Dayton Pictures and Reflections ................................................................................... 15

Ephrata Pictures and Reflections .................................................................................. 18

Forks Pictures and Reflections...................................................................................... 21

Grand Coulee Pictures and Reflections ........................................................................ 25

Kittitas Pictures and Reflections.................................................................................... 28

Mattawa Pictures and Reflections ................................................................................. 30

Moses Lake Pictures and Reflections ........................................................................... 32

Odessa Pictures and Reflections .................................................................................. 35

Oroville Pictures and Reflections .................................................................................. 36

Othello Pictures and Reflections ................................................................................... 38

Twisp & Winthrop Pictures and Reflections................................................................... 40

Walla Walla Pictures and Reflections............................................................................ 42

Wenatchee Pictures and Reflections............................................................................. 44

Yakima Pictures and Reflections................................................................................... 47

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May 9, 2005

Dear HCASB 2007 Clinics, We write this letter in humble appreciation of how much you have contributed to our students. Without your willingness to receive our students, the Healthcare Alternative Spring Break (HCASB) Program would not exist. Without you, these students’ lives would not have been impacted in the way that they were throughout their visit at your clinic. Each student expressed much gratefulness over the welcome they received from your staff in accommodating the job shadow. Common themes emerged in their reflection writing such as the amount they have learned, a deeper appreciation for medicine, and awe —awe inspired by the healthcare professionals in your clinics. This year, 22 different towns were home for 76 University of Washington undergraduate students during the week of March 19-23. For many of these eager and inquisitive students, it was their first time spending an extensive amount of time in a rural or underserved clinic. We are confident that the lessons learned from your clinic during this week will carry through their undergraduate studies, into their professional endeavors, and finally into the communities in which they will later practice. As you can see, the time that your clinic has spent investing in these students will have a lasting influence. Thank you for partnering with us in our goal to further inspire a commitment to healthcare, especially in underserved communities, in these future healthcare professionals. If there were any, please forgive us for any oversights in the fourth year of our program. We would benefit greatly from any suggestions or input, if possible- emailed to hcasb@u.washington.edu. We hope that you enjoy reading the compilation book of student reflections from all of the HCASB sites this year as a small token of our immense appreciation and gratitude toward your clinic. Please relay this message to all of the clinic staff who contributed into making HCASB 2007 a tremendous success. We hope to see you again next year! Thank you once again,

HCASB 2007 Staff

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About Health Care Alternative Spring Break Mission Statement:

The program is designed to expose the next generation of health care professionals to the specific health care needs of rural or underserved communities in Washington. By immersing the students in an interactive experience, we hope to inspire them to further their commitment to health care. Summary of Health-Care Alternative Spring Break (HCASB):

HCASB was started by students in the fall of 2003 because there was an interest in learning about rural and underserved clinics in Washington State. The program offers University of Washington (UW) students an opportunity to experience health care in these communities during Spring Break. Prior to departure, UW students chosen to participate in the project learn about their particular site and the health issues relevant to that community. At each site, a team of two to ten participants spends time observing in clinics, shadowing health care professionals, and participating in scheduled talks pertaining to specific health issues. The team will also volunteer in a local classroom to give presentations about college preparation and experience. HCASB 2004-2006

In our inaugural year, twenty UW students participated in Health Care Alternative Spring Break (HCASB). The team consisted of primarily pre-medical students ranging from freshmen, sophomores, juniors, seniors, and a participant with a masters in public health. These students were based in 6 sites in Okanogan County. Along with observing in clinics, the students also participated in college-preparation presentations.

In 2005, our number of participants more than doubled to accommodate fifty UW students. Our objective that year was to expand the participant pool to include pre-dental students. We provided these students with an opportunity to spend time in the clinics’ dental units. Along with college-preparation presentations, we worked with some schools to develop a science projects appropriate to their curriculum.

In 2006, HCASB provided a rural shadowing experience for eighty-two pre-health students expanding from pre-med and pre-dental to pre-pharm and pre-nursing students. We recognize the importance of having a diverse group of students at the various clinics because it provides an atmosphere where they can work and learn from each other. These students traveled throughout Washington State to 19 different sites and 29 clinics and hospitals.

The experiences that these students bring back from the clinics were seen on their faces and written reflections of how this trip made a positive impact on their lives and opened up their eyes about rural or underserved clinics. HCASB 2007 We hope that this year the applicants will have a chance to work beyond the clinics and in the communities in Washington State where these health care providers reside. Our goal is to select motivated applicants that not only are interested in improving the future of our health care, but also recognize the connection between health care and community involvement. Lastly, we are very thankful to all the clinics, schools, and home stays that have taken part and will take part in our program because without them, our students would never have a chance to explore and learn more about health care in rural or underserved settings. The following pages contain information and pictures past HCASB sites.

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Benton & Prosser

• Benton City Clinic • Prosser Memorial Hospital•

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“The most rewarding part of my experience was the patient interaction. A female patient was terrified as she laid on the small bed in the cold operating room being prepared for her primary cesarean. Although my role was only observation, I asked the nurse if I could comfort the patient. As I held her shaking hand, I thought to myself, “This is the BEST thing I could be doing on my spring break!” She and I joked about things like how she looked forward to fitting into her size 0 pants again. Although the conversation was an insignificant part, I felt that it had helped the whole procedure by taking her mind off of the frightening process. Thankfully, the cesarean went smoothly and as the doctor pulled the baby out of the womb, her first cry filled the room and replaced tension with excitement and relief. I later visited the newborn baby girl in OB-Gyn. The staff was extremely busy and I was helping the nurses with procedures and changing bed sheets. In the clinics, I shadowed various family practitioners and was most impressed with Dr. Lane. I was blown away by the strong bonds between Dr. Lane and his patients; he not only knew them medically, but personally as well. The doctors were extremely busy, sometimes seeing over 30 patients per day, not to mention the overwhelming amount of paperwork that needed to be completed. Even with a demanding day and only 15 minutes with each patient, Dr. Lane still managed to make each visit medically thorough and also check in on his patients’ personal lives. From this experience, Dr. Lane has shown me that medicine is a delicate art that takes dedication and passion to practice along with years to gain expertise. After many conversations with the doctors, I was put at ease with the knowledge that a doctor can make time for his or her own family and still be devoted to work. The amazing experience left me hungry for more interaction with patients. Therefore, I am studying for my medical interpreter license in Vietnamese and I also plan to get my training as an emergency medical technician (EMT). I am now more excited for medical school than ever before and am ready for the exciting challenges that will come my way.”

- Linh L.

“This experience in Prosser gave me time to observe, reflect, and see. The Prosser doctors were much more unassuming than those that I have met before. Unpretentious, willing to share their experiences, and eager to teach, each doctor divulged more information as they knew more of us. I appreciated their frankness about their profession and their patients, sharing the problems and benefits of living in a small, rural town. Following in the same relaxed pattern, the patients were very comfortable with my presence and very encouraging, emphasizing that doctors are needed in Prosser. The problems faced by the family physician that I shadowed seemed to lie in finding a balance with where to fight one’s battles, when to use authority with a patient, and how to give a patient the best care possible with the resources at hand. Through my group I learned about the future of medicine and saw the good and the extremely bad within it. We are the future of and what we make of medicine is what it will become. Learning how to treat other people, how to relate to other people, how to understand or at least tolerate other people is the cornerstone. Each and every person deserves to be treated with respect. Every health care provider should be dependable, truthful and true to their word. But complications arise when these lines are smudged. How far are we allowed to cross them, if at all? Each of us has to grapple with these questions for ourselves, and the end result of soul searching will be the future, good or bad."

- Laura W.

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“During spring break, seeing Prosser and its health care in practice was very beneficial and educational for me. This unique experience was entirely due to the enthusiasm, candor, and support that their health care professionals provided. I enjoyed getting to hear the “behind-the-scenes” commentary of these professionals’ lives as we walked through each day with them. Despite the medical setting, I never felt as though anybody was pushing us to go into a certain direction. Instead, they put emphasis on personal motivations and inspirations that had allowed them to thrive with their careers. We were encouraged to find what did the same for us, regardless of the field. They were honest about the good and the bad of clinics and working with patients. One of the doctors I worked with had been with the clinic for a long time and knew a majority of his patients for at least a few years. It was great to see the relationships he had with them. While the focus was obviously diagnosis and treatment, the conversation would often drift to everyday topics like family and friends. Most of the patients seemed to want to talk about their personal lives and concerns with him. It really highlighted the different roles that he had personally decided to incorporate into being a physician. Given the many topics patients wanted to discuss, I was surprised by how well tolerated our presence. Most understood that this was all part of the learning experience for us and seemed comfortable acting the way they normally would. This really enabled us to get a better understanding of the natural interaction between that doctor and his patients. One of the best lessons I learned came from watching the various ways different doctors would handle a similar situation. Another helpful juxtaposition was between the types of doctors that worked in different departments such as family practice versus ER. Overall, this was a wonderful program and I appreciate being given the opportunity to participate in Health Care Alternative Spring Break.”

- Farah A.

“What struck me the most was how respectful and caring Dr. Christensen was with all his patients. Although each patient was allotted 15 minutes, he took his time, and did not feel rush. It was apparent that he had formed good relationships with his patients, asking about their family chatting good-naturedly with them. One theme I encountered over and over again was the feeling of closeness and familiarity in the hospital and clinics: everyone seemed to know each other. Overall, I was very impressed by all the doctors and nurses at Prosser. They were all extremely dedicated and not to mention very kind and considerate. They answered all my questions patiently and in a satisfying manner, and explained to me everything they were doing. I’m still not sure if I would be able to live and work in a rural community, but during the time I was there, I felt very much at home thanks to their hospitality. I enjoyed the relaxed and familiar atmosphere and I truly know the doctors and nurses mean it when they say they love their job. It is the aspect of making a difference in someone’s life, of being where you’re truly needed, that rural medicine speaks to me. Whether I end up going into that field or not, I’ve really been touched by what I’ve seen in Prosser, and my desire to go into medicine has only been bolstered. This experience has shown me that medicine and healthcare should be about service foremost. In every instance, patients were treated with the utmost respect and care. That’s the kind of medicine that I want to go into.”

- Betty L.

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Brewster

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"The people of Brewster that I encountered are greatly involved in the community, which shows that people care about the place in which they live. Our host was an awesome source of information about the community because she is involved in many aspects of the community. In addition to her great hospitality, she made sure we were exposed to Brewster. I am grateful that she arranged tours of the hospital and nursing home with the directors, brought us to a Kiwanis meeting, and helped us plan a hike with one of the doctors at the clinic. In a rural community like Brewster that is very connected, making a difference requires leadership.

I was really surprised to see a large healthcare support for a small community. There is a great primary care presence that's constant, but specialists have to travel around different small communities all the time. Job shadowing the doctors was wonderful because I was able to see how they interacted with patients. They were very personable and sincere. Many of the doctors were very familiar with the majority of their patients because of the small community atmosphere. Overall, I greatly enjoyed my stay in Brewster because of the exposure to what a rural health care doctor does as well as how a rural community is run. Before this trip I thought that rural communities were just communities of themselves. However, these communities make up a large portion of the state of Washington, and there is a great need of legislation to be done."

- Julia H.

"I learned a couple of common characteristics of physicians who work in rural areas. First they like to have control over their work schedules. Almost none of the physicians that I shadowed in the past week worked traditional hours from 8AM to 5PM. They were very much involved in community development projects, such as school, church, and other non-governmental organizations. They enjoyed outdoor recreational activities, such as fishing, hunting, swimming, and hiking that one can do only in rural area.

My experience in HCASB this year has taught me not only what being a physician in rural areas is like, but also many other practical and political issues that the current rural health care is facing. I am very much grateful for this opportunity and I would be willing to participate again in the future."

- Joseph N.

"Before participating in this program, I had an interest in family practice. By being placed in a primary care clinic, I was able to see firsthand what these doctors did on a regular basis. Through this week, I realized medicine is so multi-faceted. Not only is it a scientific-based career, but it is also one in which doctors have to stand true to their ethical beliefs, deal with the psychological needs of their patients, distinguish the difference between a sincerely sick person and those who just want someone to listen to their problems, and take the time to educate the patient in regards to his or her entire health and not just one aspect of it. I also noticed that because of the relaxed nature of a rural clinic, everyone works together—doctors, nurses, translators, and office staff—thereby creating great efficiency and teamwork. Another good thing is that doctors get to see the same patients continually over the course of time. This creates a way for them to get to know the patient's personality, health conditions, and family life.

Outside of the clinic job shadowing, we were able to attend a Kiwanis meeting, a TRCA meeting (Three Rivers Community Alliance), and tour Harmony House,

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Brewster's nursing home where we shared our thoughts on the rural community and medicine in general. After the meeting, the Kiwanians offered their support and generosity towards us, although they hardly knew us. I realized that small towns are very community-oriented. Everyone knows and cares about the well-being of each other. The members are willing to make an impact on other lives. Many are motivated to start their own community projects. It would be great to be a part of a community that is interpersonal, involved, and caring. Before entering this program, I was curious about and had considered going into rural medicine. Because of HCASB, I have been able to immerse myself into a rural environment to get a direct feel of what it's really like. I enjoyed my experience this week and I would sincerely enjoy working in rural medicine when I become a physician. I've lived in an urban setting almost my entire life so I'll admit it may be difficult transitioning to a rural place because the environment is so different from what I'm used to. Despite that, I would thoroughly enjoy working in a place like Brewster where the community is small, personal, and caring."

- Alyssa V.

"Many of the doctors at the clinic mentioned that a reason they chose to live in a rural area was because they didn't view the value system promoted by capitalism, most obviously present in cities and more populated areas, to be the ideal upbringing environment for their children. I always took the view that where more people gather in urban areas was also where more opportunities were, but the view of the doctors also made sense and I never thought of it that way.

Something I really liked about Brewster Medical Center was that they had translators for patients that didn't speak English. This however, still didn't completely compensate for the culture gap because sometimes concepts didn't translate with the words. For example, one of the patients commented that his son appeared "sad". This wasn't helpful for the physician because "sad" in Spanish might have had connotations that the word in English didn't have. Also, there was a Mexican patient who was upset in having to go to so many doctors and his diagnosis changing every time. The physician explained to him that his condition was complicated and the doctors were updating their diagnoses as they received more information. However, I also sympathize with the patient because bouncing between doctors so much is expensive."

- Di X.

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Colfax

“Despite the small size of Colfax and the rural area, I was surprised and impressed

by the how closely-knit the community was with hospital. While I was shadowing a family practice physician, I was very impressed with how well he knew his patients, and it was obvious that a very close rapport existed between the physician and each patient, whether the patient was young or old, female or male. ‘It’s because I’ve known many of

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my patients for more than 15 years,’ said the doctor, who was still a youthful looking middle-aged man. ‘It’s one of best things I like about practicing internal medicine in a small community.’ It was definitely one of the most important things that I have learned during HCASB, because there is a tendency to believe that health care in urban areas is automatically of higher quality. While it is true that urban hospitals possess greater resources, impersonality of care in urban hospitals is in stark contrast with the personalized and sensitive standard of care in rural areas.

Through the variety of situations that I have witnessed, whether it was trauma care, laproscopic surgeries, or acute-care nursing, my experience at Whitman Hospital helped me realize the importance of health care professionals in a community. While the burdens of diagnosis and responsibility fall to physicians, nurses are undoubtedly the backbone and strength of a health care organization. They are the ones that provide around-the-clock support for the patient and are the first to note symptoms that will be important in the follow-up procedures of a patient. I have seen first-hand the breadth of knowledge that a physician must acquire, in addition to great amount of skill that it takes to make a timely and accurate diagnosis. I have found a new appreciation for the health care profession as a whole, which I hope to enter some day as a physician.”

- Frances M. “With the unwavering support of the community, Whitman County Hospital remains a

central fixture that acts as the sole provider of healthcare for many surrounding areas. Although small in size compared to the massive buildings with which we have trained our minds to expect, it does not fall short in its expectations, and offers a unique approach to healthcare.

During my stay, I was allowed to sit in a number of appointments and was even given the opportunity to observe a few surgeries. I was surprised by the level of patience exhibited by the medical advisors toward their patients and me, a shadow trailing them during the longest parts of their day. Their willingness to walk me through processes that have long since become quotidian events in their life illustrate the level of dedication, passion, and pride they have for their profession. In an area with limited physicians, their responsibilities have grown much greater than their counterparts working in urban areas. The knowledge of all the nurses and varying medical professions expand beyond their own areas of specialty, and they all work together more closely in order to provide their patients with the greatest level of care.

As an undergraduate, it is rare to have the opportunity to work closely in a medical environment, let alone watch patients in surgeries or be admitted into the E.R. My experiences at Whitman County hospital helped me realize what it means to work in the medical field, and allowed me to gain perspective on the unique differences that exist within healthcare in the rural areas as compared to large cities. For anyone considering a position in medicine, I believe it is important to work in rural areas as a part of training as these places accurately reflects the level of commitment needed and the type of patient care that should be expected. By being exposed to the varying types of healthcare that exist in this world, we increase our understanding of what it truly means to be a “good” doctor, and shape our minds away from the romanticized views we may harbor back into the real world where it matters most.”

- Kim P.

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Davenport Lincoln Medical Center

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“There are more rules to follow and more restrictions imposed by the stringent conditions of grant money (many of which are shrugged aside if impractical), and a rural physician may have to weigh more factors when prescribing medications, such as patients paying cash and how many free samples are available. That is what I learned about rural health care practioners: they know how to get it done. These providers are not here because they can’t hack it in the city. They are here because they want to be. It takes certain finesse: one does not practice textbook medicine here. In fact it is the urban doctor who, after a few years of practice in the city, could not handle the necessary flexibility of rural healthcare. One might be hired as an MA, nurse, or PA, but everyone pitches in where needed; everyone learns and appreciates each others’ jobs.

In small town life, if you don’t know your patient, you know his brother-in-law, cousin, or neighbor. HIPPA regulations are implemented at a whole new level, and a doctor’s appointment is also a time to chat and catch up. In rural medicine, while one might imagine that there is more red tape and bureaucracy to deal with due to more governmental and outside financial support, it all seems to dissolve in the real mission: to provide healthcare to those who need it and might not have the means to access it. To get it done.”

- Kate M. “My alternative spring break experience at Davenport was more rewarding than I

had expected. Not only did I learn new things about healthcare, the experience allowed a wonderful opportunity to be immersed in a rural community and learn about their culture and needs. Most of what I’ve learned about rural life came from my host family. I learned how difficult it was to be a wheat farmer, because they could only earn three dollars on one pound of wheat. They try to maintain self-sufficiency by growing their own livestock and getting electricity with a windmill and solar panel.

From the medical staff, I learned that in a rural community, each healthcare worker takes on a greater variety of responsibilities. In order to meet the wide range of needs, there is less specialization and more overlapping of roles. Also, health providers tend to stand out in the community as the source of knowledge and leadership. Therefore, they are very much respected and looked up upon.

Growing up as a city girl, I cannot say that I can see myself living in a rural area; however, if an opportunity arises for me to serve there short term, I would really love to continue learning about rural medicine and to gain a better understanding of the people and its culture. This program has allowed me to gain a first-hand experience of rural life instead of just reading about it in a book or hearing someone else talk about it. Not only did it provide for an opportunity for

me to be placed next to healthcare providers practicing rural medicine, it also allowed me to build friendships with my host family and another fellow UW student through the sharing this experience together.”

- Amy C.

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Dayton Columbia Family Clinic

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“Since I was a freshman, I had wanted to go on HCASB, but it never fit into my schedule. My reason for going on this trip was because I wanted to know whether I REALLY wanted to be a doctor, or I simply had all these ideas of how great it would be without ever really experiencing them. Therefore, this year, I made it happen. As I’m nearing the end of my junior year, with the MCATs looming in the back of my mind, the personal statement constantly calling me, I wondered how I would every answer the question, “why do you want to be a doctor?” I had always known that I wanted to be a doctor but to pinpoint a specific moment a specific reason was incredibly hard. I embarked on this journey hoping to learn a great deal, make new connections and be amazed, and I can safely say, that I accomplished all those things and more. From my first day at the clinic I was struck with my reason for wanting to be a doctor, from the amazing relationship that Dr. Butler displayed with her patients. I felt as if everything was coming together, as I watched the physicians be more than doctors; they became shoulders to lean on for their patients who were suffering from more than a simple illness. The atmosphere of the clinic, made it unforgettable, the small size allowed the staff to get along well, whether it be the nurses, receptionists or doctors, everyone was an equal part of the Columbia Family Clinic team. I never once felt out of place, besides being a city girl in a small town. The doctors and nurses were eager to answer any questions that I had. I will always remember how I was able to be myself, and make jokes, and it felt as if I had been there for more than a week. I always thought that I was a city girl and could never live in a small town, however, after this experience I see myself being that doctor working in the small town, because I want to be able to dedicate more than 10 minutes to a patient. I want to build that relationship with my patient, one that is extremely difficult to establish in such a large city as Seattle. I could go on and on, about the people I met, the amazing home stay we had, the awesome team member I had, everything was amazing, and one week was definitely not enough. If I had to sum up my experience in one word it would have to be AWESOME, because there is simply no other way to express, the experience I had. This will go along with my trip to Spain as one of the greatest experiences in my college career.”

- Ngoc Thien N.

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“I can definitely picture myself practicing in rural medicine in the future. At Columbia Family clinic, I witnessed teamwork at its absolute finest. There was no hierarchy of health professionals. On Tuesday, my teammate and I witnessed the intubation of an elderly woman who was placed in acute care for emphysema. She had spent the entire night in the ER but had to be flown to Spokane Hospital that morning. Everyone in the room worked closely together: Dr. Butler D.O., the Physician Assistant Ken, one nurse, and a

Respiratory Specialist. It was truly amazing. Furthermore, the patient-doctor relationship was wonderful. Dr. Luce M.D. and Dr. Butler D.O. had close relationships with nearly all of their patients and their families. They had become familiar with their patient’s history, family values, weaknesses, and strengths. This is often neglected in some urban medicine practices. On several occasions, patients said to me, ‘Dr. Luce saved my life!’, ‘Dr. Luce is the reason why I am alive today!’, and ‘You should be like Dr. Butler when you graduate from medical school!’ The quality of patient care provided by the healthcare professionals at Columbia Family clinic is beautifully revealed through these statements.

This experience allowed me to have a closer look into the dynamics of rural medicine. Shadowing an Osteopathic and an Allopathic doctor provided me with hands-on experience to further explore their similarities and differences. Shadowing a Physician’s Assistant (PA) allowed me to truly see the importance of having a strong and trusting relationship between the physician and the PA. Presenting to the high school students allowed me to motivate the students to pursue higher levels of education, and it allowed me to serve as a good role model and mentor to them. Through this experience, I witnessed teamwork at its finest. I witnessed an amazing quality of patient care that is often difficult to find in urban settings. I witnessed remarkable patient-provider relationships that again may be difficult to witness in urban settings. I am truly honored for the mentorships and friendships that I developed with the healthcare providers of the Columbia Family Clinic and with the residents of Dayton. Dr. Luce and Dr. Butler were wonderful teachers and mentors whose dedication to medicine is truly remarkable. This experience has furthered my interest in the field of medicine and healthcare, and I am truly thankful for all of the wonderful insights and experiences that I gained. I am strongly considering rural medicine for there is nothing that can compare to improving one’s life and helping those in need.”

- Josephine Q.

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Ephrata

• Ephrata Medical Center • Columbia Basin Family Medicine • Columbia Basin Hospital •

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“The town is beautiful in its own way: with running tumbleweeds, amazing sunsets, empty hills, and clear moonlight nights. I enjoyed how friendly everyone in the town was. My home stay was with the doctor I was shadowing and he would always leave his door unlocked. Everyone in the town, including the pastor, doctor and nurses made us feel a part of it. They all gave genuine trust to us students automatically; we did not have to do anything to get it. The authorities of the town were welcoming in a way which is rare in larger towns like Seattle. Small towns have their own charm. As a result, I could see myself practicing in a small town. However, I might practice as a specialist instead of a family practice doctor. This experience made me interested in practicing rural medicine. Small towns have trust and security that can only be sought after in larger towns.”

- Monica K.

“I was surprised by the number of patients that came in for psychological problems. There were people of all ages that came in for pills to treat depression, anxiety, and bipolar disorder. Because my past experiences with medicine dealt with infectious disease and wound care, I did not consider mental health to require so much attention. Concerning the issue of cultural competency, I noticed a lot of Hispanic families could not speak English well enough to communicate their health needs. In one case, a man brought his daughter to translate for him. The doctor told me he did not advertise that he can speak Spanish, but many doctors in the area are competent in Spanish, letting the patients assume they will be fine to come alone. Other issues I found remarkable during my shadowing in Ephrata occurred with the prisoners. Many of them required medical care because they had been harmed by other prisoners. The entire experience with the prisoners was interesting and many were very respectable when receiving health care. They complained a lot about the other prisoners and I gained insight into prison livelihood.

My experiences in Ephrata have greatly changed my perspective in health care. Before, I had not considered family practice in my future. After shadowing Dr. Allred, I started to appreciate the doctor-patient interaction in his private practice setting. It is great to see how Dr. Allred took time to get to know each of his patients. I think this is an advantage to rural medicine, for I want to have great relationships with my patients that go beyond their current health status. There are so many problems with health care in the United States today that will most likely not be fixed by the time I am a physician. It worries me to see health insurance companies dictate what drugs patients take. It also bothers me that many poor people are denied proper health care because Medicaid or Medicare sees an alternative that will minimally pacify the patient. Dr. Allred and I talked about many of the problems in health care today and the possibility for universal health care in the future. It was really interesting to listen to his views from years of experience. I have learned much, which gives me more reason to pursue a career in medicine. Health Care Alternative Spring Break definitely challenged my passion for health care and encouraged it at the same time.”

- Rachael S.

“I have been contemplating becoming a rural physician and this trip has allowed me to see the benefits of rural areas. Doctors are able to become more familiar with the populations they work with mainly because they live in the same community. Because resources are limited, they must learn a broad range of skills and do jobs that would

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otherwise be handed off to a specialist in a large city. I could imagine myself serving and living in a tightly knit community in the future.”

- Kim D.

“I felt that the doctors were very generous with all the knowledge that they conveyed. They showed me charts, diagnoses and various types of medicines. I picked up a lot of fun brochures, and reading items from the doctors. Some of the things I got to see were geriatrics patients who had Alzheimer’s, pain medication, and dementia in many cases. The elderly were so nice and friendly with all the students as well. I also had fun seeing a bone rotation on a young girl due to a fracture. She was put into a cast subsequently. The other interesting thing I saw was a few patients that were pill junkies and the doctors had very keen eyes to avoid prescribing pills to such patients.

I enjoyed the hospital, clinic and nursing home combined establishment. We had a great pastor taking care of us and a whole host of nice people who always welcomed us. I had a great time and definitely had new experiences that I could never gain at a large hospital such as shadowing for an entire workday under one doctor and rotating to different physicians each day. Thank you for the opportunity.”

- Sayed I.

“I had volunteered in hospitals and clinics many times, but this experience was unique in that I was able to talk to the doctors personally about a large range of topics, from problems with our current health care system to jokes about their favorite comedians. This one-on-one time with the doctors gave me a chance to really explore the life of a health care provider. Each day we rotated between doctors and nurses, getting the chance to hear about medicine from many different perspectives. I particularly enjoyed the atmosphere of the rural clinic because the health care providers knew most of the patients. Upon entering the room, we would spend at least ten minutes discussing about the patient’s life, hobbies, etc. before delving into the reason for their visit. Each patient was treated with genuine concern. This helped to create a trust between patient and doctor, something that is becoming rare in large-town clinics.

I enjoyed my time the most shadowing a doctor who was also the Grant County Public Health Officer. I have a great interest in public health. I enjoyed talking to him about the current health care situation in the United States, how rural medicine differs from urban medicine, and long-term solutions to fixing access to health care.

We normally get several emergency room visitors a day. Most arrive by ambulance, simply because they did not have a car, and ask for unnecessary pain medications that will ultimately be paid for by taxpayer money. Other patients arrive with a long laundry list of medications they needed refilling. Still, more patients come demanding antibiotics for their viral infections, only later to complain the antibiotic no longer works for their bacterial infections. People seemed to know what their problem was and wanted a quick and simple pill to alleviate whatever symptoms they have. It was sad to see that we as a society are becoming greatly dependent on medications. I truly sympathize for the nurses who have to listen to the complaints of the patients when their medications fail to relieve their problems within the first ten minutes of taking it. HCASB allowed me to experience the lives of doctors and practicing medicine beyond medical school, it was an “eye-opening” week that has impacted how I view healthcare.”

- Parhum N.

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Forks Bogachiel Clinic • Calawah Medical Clinic • Sol Duc Clinic

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“In a nutshell, my time at the Bogachiel clinic (which was the walk-in clinic of the community hospital there) was really beneficial and mind-opening...I got some insight into how [the doctors] felt…there was a drive to dedicate themselves to a community they were intimately connected with (since it's a small town) and I could see when they were pleased or when they were stressed, the emotions that fluctuated as they passed from patient to patient. On the other end, they explained to me how they became a doctor, how they manage being one and at the same time have a

family (one doctor had eight children), and how they had really gotten to know the community through their profession. Among the many interesting things I saw as I shadowed doctors at the clinic was an actual surgery; one doctor allowed us to watch a tubule ligation (tying one's fallopian tubes to become sterile). It was really amazing just being able to watch the surgical procedures and the interactions between the doctor, the nurses, and the nurse anesthesiologist as they worked together to get the job done.

Overall, I'd have to say that I was very much enlightened, not by just what I'd seen in the clinic, but of the town in general. I'd come in with presumptions which for the most part were changed for the better after a week. I'd gotten to know the staff at the clinic and our host family a little better, and I was beginning to feel connected to the town. I left Bogachiel knowing that I would miss it…it's solidified my commitment to become a doctor.”

- Myra A.

“I found the people a lot less ‘rural’ than I expected, but definitely live differently than I do. The high school students looked similar to my own high school and the people coming to the clinic were similar to those found in my own hometown. I loved working in the clinic and find myself thinking more and more about rural medicine. The doctors there were not only family practitioners but also were marriage counselors, educators and parents. I feel that a rural setting would give me more flexibility than the city and the pay is quite comparable.

This experience has definitely helped me change my opinions about rural communities and how I fit in them. I got to see so many interesting things in Forks. From tubal ligation surgery to well-child exams, I’ve learned lots of cool medical facts and new things about people living in different areas and in different conditions. This experience has helped me to confirm what I want to do with my future and has given me options to where I can go with my education and beyond. I have truly appreciated this opportunity and will always be grateful to the many people that made it possible.”

- Aimee F.

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“One experience I will always carry with me is watching the live birth of a baby boy named James. The doctor, who had previously received permission from the mother, called us at 5:30 a.m. I guess it was good practice for if I ever become an obstetrician. So many feelings swept through me as I watched the birth of a new life. I was horrified, amazed, shocked, awed. I learned and felt so much during this one-week period of job shadowing. Although I thought this experience would clinch my decision to either pursue or not pursue medicine, I ended up feeling even more confused about my future career path. This is because now there are even more details and perspectives for me to consider. However, ultimately I am grateful for my Health Care Alternative Spring Break experience since it will help me make a more informed decision in regards to my future career choice.”

- Kimberly C.

“My HCASB experience has profoundly affected my views of health care. Before the trip, I had little hands-on clinical experience and wasn’t sure whether I would like the daily experiences of medical practice such as paperwork and recalcitrant patients. However, I realized during this trip that being a practicing doctor is something that I want to do. While it’s true that there is little drama or glory in family practice, I think I would enjoy being able to help people fix health problems that, though not necessarily life threatening, can have a huge effect of

the patients’ quality of life. My shadowing experience showed me how valuable it is for a family practice

doctor to have an ongoing relationship with their patients, and how living in a small rural town facilitates that. To my surprise, I found that one of my favorite parts of the week was interacting with the patients, especially the pediatric patients. The humanity and compassion exhibited by Dr. Dickson of Forks inspired me and showed me how important it is to treat the entire person along with the affected body part. He knew the families, jobs, and interests of each of his patients, and was able to put them at ease by talking about their friends or recent events in the town...In addition, he was willing to take the time to share his experiences with my cohort and me, and answered all of our questions. He even gave us some basic medical tools, like stethoscopes, and let us take them back to our host family’s house and practice on the other members of our group. Because of my experience on the HCASB trip, I can more clearly see myself as a family practice doctor.”

- Kelly F.

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“[Dr. Shima] would go over every single question with every patient about their condition. I liked the way he practiced medicine because he was a very caring and knowledgeable doctor. He allowed me to interrupt and ask him questions at anytime; he was able to explain things happening inside the body at the simplest level for anyone to understand. He used visual stimuli to help his patients understand what is happening to them or what happened to them…I gained more knowledge about what it takes to be a good doctor. Thanks for the opportunity and educational experience.”

- Jackelin T.

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Grand Coulee

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“My HCASB experience definitely helped to make me even more aware of some of the issues facing rural healthcare on a more emotional, guttural level to complement my previous cognitive, theoretical awareness of these things. Though I loathe to admit it, up until HCASB and several events in my life, I really was not entirely sure about pursuing a career in medicine. Is my heart in the right place? Who am I pursuing this degree and this education for? Am I willing to adopt the lifestyle of a physician? These were all questions swirling around in my head only several months ago, and I think I can now safely say that the fears associated with those questions have mostly dissipated. I know now where I stand in my relation to my fellow global and national citizens and I believe that my beliefs on the service the physician provides are wholly in line with what I want to do and be in the future. In this respect, just having the opportunity for this extended shadowing experience with such a great team of dedicated, personable professionals has really helped to quell the fears and apprehensions I had harbored for so long. Furthermore, I have, for some time, been fully intent on lending my services (upon finishing up my education) to underserved populations outside of the country. Now, after HCASB, I realize on a more complete level the importance of serving the underserved within our own country. Now, this is not for any reasons arising due to any kind of absurd patriotism or nationalism on my part, but more due to the opening of my eyes to the reality that not only are people in developing countries lacking in proper healthcare; these problems exist very much locally.”

- Terry L.

“I do not know if I could live in the Coulee area, but after this trip, I am definitely considering rural medicine as an option in the future. I think that a career in rural medicine would be very difficult and at times stressful, but also very rewarding. There is always a need for more people, and you have to deal with a larger range of issues than in an urban setting where there are many specialists.

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This experience has definitely been one of the most insightful that I have ever had, and it has given me a view of medicine that I had never had before, and it has only motivated me more to want to go to medical school.”

- Brian F.

“The best experience that I got in the clinic was the opportunity to shadow an orthopedic surgeon. Since orthopedics is my interest at this point, the surgeries and clinic visits combined with simple conversations about opportunities in the field provided me with incredible knowledge about the profession. The added plus was that this information was in the context of rural medicine.

One thing that I was relatively certain of at the beginning of my trip was that I was not very interested in a rural setting. I wanted the excitement of working in a nationally or even world renowned facility with experts that cannot be surpassed. I wanted to serve in a fast-paced, exciting environment. I learned over the course of the last week that my desires could actually be met in a rural setting to an extent. The doctors in these facilities may not be known around the country, but they are brilliant, warm individuals that I would be blessed to work with. Interesting cases and emergency surgeries are not mythical in a rural setting as I had initially imagined, so I would still have the intellectual stimulation that I desire.

All-in-all, this trip taught me the benefits that rural medicine could provide me as opposed to what I could provide it. It has sparked an interest in me to serve in rural communities.”

- Erika K.

“I never really understood what it meant to be a physician. I had first thought that doctors' duties only included performing surgeries, prescribing medication, and having annual check-ups, but they have much more responsibilities than just those. They have to dictate notes about the examination, diagnose the illness, discuss with the patient the various treatments available, and answer any questions the patient may have.

Everyone has so much energy at the clinic. The work environment is so wonderful. The doctors, nurses, and staff are amazing since they bring so much enthusiasm everyday to work. They try to make the best of every day and are cheerful no matter what may occur which is an ability I hope to have one day. Despite facing many hardships, they overcome the sadness by looking forward to treating and saving other patients. They deal with the tragedies through supporting each other.

I really enjoyed my trip to Grand Coulee, I am grateful to have this wonderful opportunity to meet the doctors, nurses, staff, and people of Grand Coulee. By shadowing the doctors and nurse practitioners at Coulee Family Medicine, I have a better understanding of what being a physician really means. After attending Health Care Alternative Spring Break, I am even more determined to become a physician. I would like to thank Dawn, Dr. Castrodale, Karen, Dr. Chaffee, Wheatie, Sharon, Janet, Terrie, all the nurses, and staff at Coulee Family Medicine and HCASB for allowing me such a great learning experience!”

- Amy T.

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Kittitas

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“I have learned so much through this experience, and I am very grateful that the Home Health and Hospice Clinic allowed our group of pre-meds to follow their wonderful practitioners during the week. Everyone was so gracious and eager to answer our questions and teach us about their profession. They provided invaluable insight to our potential medical careers from a firsthand perspective, and their advice has helped me considerably in deciding what kind of medical career I want to pursue.

I am very grateful for the intimate, extended contact with patients that nurses and other lower level practitioners experience in their daily work. I was so touched and inspired by the passion with which these people serve the community, the desire they have to improve their patients' conditions. This loving touch I aspire to have as an intricate part of my practice, as this compassion is often lost in the rush to see as many patients as possible. This to me is the heart of medicine, the very roots of its existence, the genuine compassion for those who are suffering, and the active effort to relieve that pain.

Overall I would suggest this experience to anyone considering a career in medicine. The firsthand exposure to these unique medical situations is unmatched by any other experience, because you are not only an observer but a participant with your questions and interaction with the patient. This HCASB trip has been so motivating and reaffirming of my desire to practice medicine, very likely in a rural setting where care is needed the most. Whether I end up in such a location or not, I know I will incorporate the values and the passion displayed by these wonderful caregivers wherever I may practice.”

- Jon K.

“Ellensburg was a great community and I wouldn’t hesitate to go back there again. The most interesting part of this whole experience was the opportunity to go with the home health nurses to patients’ homes. I thought the days of home health care were over. The patients were so hospitable and watching the nurses drawing blood, providing wound care, and a variety of other procedures while carrying on a pleasant conversation was really amazing. It was obvious the nurses had developed a great rapport with their patients, not out of necessity but because they really cared.

Honestly, HCASB was something I pushed myself to do because I thought it was something I “should” do. What better way to show my commitment to medicine than to go experience healthcare in a rural area, I thought. My trip to Ellensburg has become so much more than that. Prior to this trip, the thought of practicing in rural areas seemed almost absurd. Now, it is not only a possibility, but I welcome the opportunity to be able to serve communities like Ellensburg. I realized that I don’t have to go to a third-world country to find people in need of good physicians, there are so many right here in our own state that need us.”

- David D.

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Mattawa

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“From the moment we first pulled into Mattawa, I knew I was going to be spending my week in a place very different from my home. I noticed the large population of Mexican immigrants had a culture quite different from my own. I saw a couple of Native American patients and noticed differences there.

I saw how important it is to understand and deal with cultural barriers in rural medicine, whether they are financial (having patients pay for treatment), linguistic (communicating with patients), or educational (explaining conditions to patients). I was amazed how diligent the practitioners at the clinic were in delivering high-quality care. They put much time and effort in teaching their patients things they needed to know, and in following up after visits.

My HCASB experience this year was quite different from the one I had last year in a Moses Lake OR. I saw what family medicine is, and how integral it is to the future success of health care in this country. Family medicine practitioners are on the front-line, providing preventative care that will make our system sustainable. I am still unsure as to what area of medicine I want to pursue. But I now know more about an important area through my experience in Mattawa.”

- Chester C.

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Moses Lake Moses Lake Clinic, Parkview Pediatrics & Family Medicine Clinic,

Samaritan Healthcare

“Being able to shadow three doctors and a nurse practitioner in less than a week provided many insights into the world of health care providers. Yes, that aspect of the experience was pretty cool, but there was also the fact that this clinic is an eastern Washington town of ~17,000 which is about half the size of the UW’s student body!”

- June B. “This spring break experience allowed

me to learn more about the field of medicine in a rural community in five days than I have learnt in all the years I have spent in the classroom.”

- Jenny D.

“I noticed that every single doctor I met absolutely loved what they do for a living. It was clear from my observations that at least for doctors in Moses Lake, being a physician is personally satisfying. Many, in fact, tried to convince the students with great passion to practice medicine or do rotations in Moses Lake in the future. The small town atmosphere is clearly very conducive to the teamwork that makes medicine successful.”

- June P.

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“To my surprise, the doctors know all their patients not just by their health condition, but also by their personal life. I think this is a very good practice that every doctor, whether in an urban or rural setting, should have. This was something very inspirational to me. I will take this into consideration in my future practice in medicine.”

- Sandie H.

“I realized that I had gained admiration for the rural physician and the many roles they play in their communities. They serve as advisors, advocates, teachers, role models, and healers simultaneously. I only hope that my future leads me down a similar path upon which I can contribute as nobly to my community.”

- Lauren H.

“Before this experience, I would never have wanted to work in such a small town since I am so used to the big city and being around a lot of different people. But seeing the patient/provider interaction made me think otherwise. Who knows, maybe ten years down the road I may be in a rural city, speechless that premed students come to volunteer on their spring break!”

- Thao Phuong L. “Shadowing in the Walk-In Clinic enabled me to see the diversity of the Moses

Lake community. One thing that caught my notice about Moses Lake is just how friendly and kind the residents are. The small-town atmosphere seems to foster a greater sense of unity and camaraderie among the residents. For this reason, I can definitely see myself working in an area like Moses Lake after the completion of medical school.”

- Stephanie O. “This experience was deeply enriching. I gained a profound respect for the team

work put into delivering health care and the importance of diligence in patient care.” - June B.

“I found it fascinating when patients came to their doctor primarily to discuss daily

non-health related issues. I realized that in this smaller rural region, the doctor plays an

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integral role in community infrastructure, culturally, socially, religiously, and in a healthcare-oriented manner. And perhaps someday I will be in those shoes.”

- Jenny D.

“I really admired the way the family practice doctor was knowledgeable and cunning enough to work the system in order to best serve his patient. The need and the creativity involved in rural healthcare inspired me to pursue a career as a rural physician with a more open mind.”

- Sarah B. “I was able to witness the close interactions and carefully cultivated relationships that the pediatricians, family practice doctor, and nurse practitioner I shadowed had with their patients and their families.”

- Lauren Hanson

“When I shadowed with the Walk-In clinic physician and the Family Medicine

physician in Moses Lake Clinic, the experience had opened my eyes to the rewards of those areas of medicine. I really enjoyed being able to interact with a very diverse patient population and see how the physician played other roles, such as mentor and counselor, with the patients. I am now leaning more toward primary care rather than specializing in a specific area.”

- Stephanie Ortman “My experience in Moses Lake reaffirmed my faith in medicine as a healing field and one that focused on the greater good of society in general.”

- June Peng

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Odessa

“I learned that medicine in a rural community is definitely more integrated than in an urban city like Seattle. In a city, a patient may be referred to various doctors that specialize in a particular field of medicine whereas in Odessa, a single doctor must be able to handle a variety of these cases. There is only one doctor in Odessa. The hospital contains 2 operating rooms and no surgeons. The only times these rooms are used are when a surgeon from the nearby town of Davenport comes approximately once every 2 weeks. These dynamics give you an idea of how much more responsible the doctor becomes in caring for patients with any one of a vast number of problems.”

- Meeral S.

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Oroville • Oroville Family Medical Clinic •

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“The wonderful clinicians made us feel welcome from the start. I appreciated how they showed a genuine interest in our learning by taking the time to discuss a patient’s medical history with us before we entered the exam room. The logic behind a diagnosis and course of action was explained in detail each time, which was extremely intriguing…

One of rural health’s greatest rewards is the opportunity to see patients throughout their entire lives, from birth to death, forging lasting friendships and developing a deep appreciation for the community along the way.

It was amazing how much we learned and connected with the people we met during the week. The staff inspired us to new levels of kindness, self-sacrifice, and dedication - they showed us that primary care requires great individual flexibility and a wide range of skills to accomplish many different tasks. Healthcare Alternative Spring Break was an exhilarating and fantastically informative learning experience. I left Oroville with new insight into what being a physician really entails, and I am eager to consider the surprisingly exciting field of rural medicine as a future focus.”

- Mindy S.

“The experience was enjoyable and enlightening… kudos to all the organizers who made it happen.” -- Phu V.

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Othello

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“Columbia Basin Health Association (CBHA) was reminiscent of the works from Architectural Digest; the sharp contrast between the colors, impeccable coexistence of function and beauty, majestic yet welcoming, CBHA was an enlightening structure exhibiting what rural healthcare could and should be. With its state-of-the art technology, the clinic was attending for all the needs of the patients, irregardless of the fact that most could not afford the treatment fully. Money did not play as a factor at Othello; many of psychological and behavioral interventions were given to the patients free of charge, and the clinic did their best to get around the fact that most of its patients lacked insurance, transportation, or even a green-card. We got to witness the unending efforts for the best care for patients from home visits to offering transportation to hospitals in Tri-Cities or Spokane. Furthermore, 70-80% of the inhabitants were Mexicans or indigenous Mixtecas where corresponding interpreters were readily available. In fact, most of the doctors and nurses spoke fluent Spanish. This is what I have idealized for urban healthcare, and even though I was biased into thinking that healthcare in rural settings would be sub-par compared to the city, in reality it was the opposite. We were able to witness the potential and goals that we should follow and in truth, the doctors at Othello were working harder than a doctor in the city that performs twenty procedures a day. Their actions remind us that we are not simply treating a disease or damage, but a person as a whole. Until we attend to what the problem is in the heart and the mind, we continue to perform sub-par service to our patients.”

- Roderick K.

“My experience visiting the little town of Othello was an adventure that I will never forget. I had so much fun getting to know the Reeders, my host family, and got to meet so many amazing doctors, nurses, and hospital coordinators. The preconceived expectations were completely altered by the end. Being the first time that I have shadowed a healthcare professional, I felt a plethora of feelings. At times I was reassured of my passion of pursuing a career in medicine and at other times found myself disappointed and disheartened by the attitude of particular doctors. By the end of the week though, I learned an immense deal regarding the reality of healthcare.

My week started out by working in the pediatric department working with the nurses and Dr. Mata, a pediatrician…Dominated by a Hispanic patient population (about 75%), all of the nurse assistants, front desk workers, and a majority of registered nurses were fluent in Spanish. In Columbia Basin Health Association (CBHA), I got the opportunity to meet Dr. Bunch, a family care doctor. He was interested in what I was doing and networked me to people that he knew regarding my interests. I happened to express my interest in shadowing in on a surgery, and he connected over to the hospital next door where the operations took place where I could observe surgeries. He was an amazing teacher and convinced me to return over the summer to work more extensively with him.

Overall my experience was a blast and I am glad that I spent my spring break in Othello. I was able to meet amazing individuals and see the culture of a Spanish-speaking population. I also was able to connect with a doctor that I feel can teach me a lot and guide me in my future.”

- Paul L.

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Twisp & Winthrop

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”My trip to Twisp was an unforgettable experience. Even though only about 7,000 people live in this old country style city, there is nothing old fashioned about Dr. O’Keefe’s practice. With new technology and customized techniques, he offers the best care for the people of that region which consists of a mostly upper middle class population. However, Dr. O’Keefe never lets his patients leave his office without a gleaming smile and even more satisfying discounts. Upon our arrival, I was lost in the beautiful and majestic scenery of the city. The farm animals, apple trees, and deer on the side of the roads made the region appear so peaceful and welcoming. The outdoor activities were abundant. For instance, biking, jogging, hiking, skiing, horse back riding and fishing were the most popular activities that Dr. O’Keefe’s three day a week business allowed him, his family, and his staff to enjoy. However, being so far away from city distractions and missing out opportunities offered by the city life lead me to be more found of living and practicing in a small city rather than a rural area. I would love to provide care while going on a vacation similar to many of the Twisp residents.

Although Twisp consisted mostly of affluent citizens and thus, we did not witness any large socioeconomic status differences within that population, there were huge differences when comparing Twisp to Okanogan where the majority of patients were immigrant workers and lower middle class people. This experience has affirmed my decision to dedicate a portion of my life to volunteer in rural areas where the patients are not people who just come and go out of the office, but with whom I have developed strong relationships. They are people who I will interact with every single day as the city’s only baker, butcher, grocery owner, etc. Finally, I want to thank Dr. O’Keefe and the people of Twisp for giving me the opportunity to be part of their community and gain such a unique experience.”

- Farazi S.

“Before this trip, I had spent some time in different rural communities. Specifically, I grew up in a small Alaskan town and have spent the past two spring breaks in Forks, Washington as part of Pipeline’s Alternative Spring Break Program. I understand that the definition of rural can translate differently for everyone. It can include possibly isolated geographic location or even economic status. I was pleased to observe the practitioner to be aware of his patient population and flexible while working around economic, age, and geographic constraints. Cultural competency was often a discussed issue throughout the town once they understood our program goals and we were all expected to have a working knowledge and vocabulary. I appreciate that our opinions were respected. In fact, it was recommended to us that we take a trip to nearby Okanogan which had large Hispanic population. We visited this clinic which served lower-income patients and had the chance to learn more about Medicaid coverage.

This trip left me convinced that dentistry is the right career choice for me. I am definitely excited about taking care of my own patients’ dental needs and possibly running my own practice. Visiting Twisp has specifically left me considering the benefits of working in a smaller community as well. Thank you for the opportunity!”

- Paris S.

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Walla Walla

Yakima Valley Farmers Clinic/Family Medical Center

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“I have been to many parts of eastern Spokane, but never to Walla Walla before this experience. It was definitely an incredibly interesting and eye-opening opportunity and I am very glad that I signed up for HCASB! I got the unique opportunity in that while my doctor had her day off, I was invited by the community health workers to shadow them. I am a public health major and had expressed interest in their work. I followed a social worker to a home visit concerning a child taken by CPS, which was really interesting, and sit-in on “first steps” appointments, a program which provides information, nutritional guidance, and things like car seats to poor mothers. It was interesting to see this program help many women who may not know much about pregnancy and how to eat right to have a health baby.

Something which impressed me was how close-knit the clinic community was in such a small town. I really enjoyed the small family practice aspect to the clinic, where everyone knew each other and the building was pretty small. The doctors were also very dedicated to the cause of reaching the underserved and providing affordable healthcare, something which was really inspiring to me.”

- Johanna H.

“By job shadowing at Walla Walla’s Family Health Center I was able to observe the realities of practicing medicine and the challenges it entails. Running a clinic is a group effort. The physicians, nurses, pharmacists, receptions, and other workers must constantly cooperate and translate for one another to ensure that a patient’s needs are met. Everyone works a busy schedule to handle the large number of appointments and fills out piles of paperwork to keep records. Three of the four days I observed at the clinic, my doctor had to skip his lunch to take care of email or attend meetings.

Job shadowing at the clinic allowed me to see many of the health problems experienced by a rural, mostly Hispanic, population. The most common were diabetes, arthritis, obesity, heart disease, and above all, substance abuse. I remember one individual who bargained with the doctor over how many hydrocodone pills he should be prescribed, and another who was caught renewing her methadone prescription a few days earlier each month. For this reason, the clinic had a new policy of having patients sign pain management contracts to prevent the selling or becoming dependent on their pills. Nicotine and alcohol addiction were also prevalent. The doctor I shadowed encouraged many to quit usually hearing the reply, ‘well I guess it’s your job to tell me that, and I guess it’s my job to listen but it’s easier said than done.’ I was surprised by how many people had mental health concerns such as depression and bipolar disorder. There is only one psychiatrist in Walla Walla’s population of 20,000 and no in patient ward, so many individuals have no other place to go aside from their family doctor.

Although working as a health care professional in a rural community is challenging due to the large number of patients and illnesses, it is something I am willing to consider after going on this trip. Walla Walla is a close knit town where people know one another in town and can tell the directions to any local cafe, school, or church. Having grown up in the city, I think I would enjoy moving to such a place where there is a greater sense of community. In addition, I have realized how high the demand is for mental heath professionals, a field I would like to pursue as a Psychology major. In sum, I am grateful for having the chance to participate in HCASB because it opened my mind not only to the difficulties, but also the rewards of helping underserved communities.”

- Ella K.

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Wenatchee

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“What I loved most about Wenatchee were the people. Everywhere I went the local people were so friendly, especially at Columbia Valley Community Health. Having volunteered in a number of medical settings such as Children’s Hospital and UWMC, I loved how the entire staff was so friendly and helpful. Unlike the city where one can feel like a burden in a busy, fast-paced environment, the entire staff at the clinic made us feel welcome and comfortable. Before this experience, I had always felt that family practice was boring and not for me. After this experience, my view of family medicine has changed completely. After shadowing numerous doctors, I came to greatly appreciate the close relationship between doctor and patient. Some of the doctors treated entire families making them more than just a doctor to their patients. Also, I loved the wide range of cases a family doctor could encounter. Unlike specialists who know a great deal of information about a specific area, family doctors know a little bit about everything.

Overall, I felt that each doctor I shadowed truly enjoyed their job. Although I don’t know if family medicine is the career path for me, I feel that Columbia Valley Community Health is doing something really great and I hope to someday find a career that I love just as much as the doctors I shadowed loved theirs!”

- Simran K.

“Columbia Valley Community Health is a pretty nice size

clinic. They have a variety of services, including doing some minor surgeries. The patient/doctor interactions that I observed were really different from big city doctors. The doctors at Columbia Valley Community Health (CVCH) really took time to talk with their patients. Some even took up to 40 minutes talking with their patient whereas the doctor I go to takes only like 10 minutes. The respect for doctors was remarkable. Even the pharmacists took a lot of time to explain all the details about the medication to make sure that instructions were really clear. What struck me was that maybe more than half of the patients couldn't afford the medication they needed. This is such a big difference from Seattle. But the clinic tries hard to help make medication affordable to their patients.

The most exciting part for me was probably getting hands on experience, although it wasn't a lot, I still had the chance to do some. I also really enjoyed the friendliness of everyone at the clinic. Everyone made us feel welcome.

Besides from the clinic, our host family was absolutely wonderful. They were very sweet and accepting. We got to ride their horses; something I've never done before. Overall, I had an amazing time. Thank you for making this possible!”

- Tiffani N.

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“I really grew to love Wenatchee after my short stay there. Wenatchee seemed very calm to me and being surrounded by the beautiful hills, fruit trees, and minimal traffic was refreshing.

I don’t think I will ever forget our host family. They were such loving people! As soon as we arrived, they greeted with hugs and treated us like family from then on. It was a busy week as they had an open house on the day we arrived, sold the house on Tuesday, took us to see a house with them on Thursday, and put an offer in for a home on Saturday. Despite all that, they took the time to show us around Wenatchee and spend time hanging out with us. I am very glad to have met them.

The clinic was amazing as well. Everyone there was so kind and helpful—I was blown away. I was surprised by how many CVCH employees spoke Spanish, especially when many of them told me they learned mostly by immersion. It was

obvious to me throughout my whole stay there how important communication and cultural competence is in health care. I grew to really admire and respect the doctors for the added challenges they have to overcome when working in a rural clinic and saw the value of practicing outside the main cities.

I also appreciated the chance to shadow so many different people as it gave me a broader understanding of how people work together at the clinic. For example, I sat in on an appointment with a patient in the morning, watched her lab tests being performed, and then saw the prescription getting filled in the pharmacy later that day. It was nice shadowing different doctors as I got to see a whole spectrum of personalities, doctor-patient interactions, and methods of balancing appointments and all that paperwork. Not only are the people at CVCH great healthcare providers, but great people as well. Many of them took the time to ask about patients’ lives outside of his or her health issues and allowed me to see one aspect of being a doctor that had originally attracted me to the profession. Before this opportunity, I was unsure of what area of medicine I wanted to pursue. I am definitely leaning toward primary care now.

Muchas gracias to everyone for this priceless experience!” - Elice K.

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Yakima Central Washington Family Medicine

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“Having volunteered in a large urban hospital, I thought I knew pretty much all there was to know about the professional setting of a health care environment. However, I was very much in the wrong. Not only was this a governmental nonprofit clinic open to the public, Central Washington Family Medicine also operated on an important trigonal system. The doctors were not the all powerful ones atop a hierarchal structural with nurses being ordered around; rather, three important groups, the pharmacists, the nurses, and the doctors, formed the triage legs of a stool. They worked together in order to exchange information and provide the best possible care for the patients. Seeing this decentralized system rather than a firmly set hierarchy has opened my eyes to see the various operational types of hospitals and clinics, each founded in order to provide the best possible healthcare. As a team worker, I would love to work together with health professionals in other fields, so in the future I hope to be able to practice in such a place where professionals of all kinds work together, and not against each other.”

- Melody M.

“My experience at Central Washington Family Medicine confirmed my decision to practice medicine in a rural area. I grew up in Prince George, British Columbia, a small logging town in Northern Canada with perhaps the same population size as the city of Yakima. I am drawn to the intimacy of small town doctoring and the increased opportunities for patient contact. Although I attended HCASB as a premedical student, my experience in the clinic allowed me to shadow pharmacists and revealed a new side of pharmacy to me that hadn’t been apparent from my year of volunteering at Evergreen Hospital’s Inpatient Pharmacy: consulting pharmacy.

I spent my last afternoon at CWFM with Dr. Louise Achey, a vibrant, amiable woman with boundless energy, optimism, enthusiasm, and empathy for her patients. Before seeing her anticoagulation patients for the day, she briefed her pharmacy student (and us shadows) on her patients’ health and personality quirks, sharing their likes, dislikes, interests of the moment, and activities. Her attention to these details and her interactions with her patients allowed me a glimpse into the intimacy of rural medicine that I had been seeking.”

- Andrea M.

“Spending my spring break week in Yakima allowed me to gain a perspective on learning and practicing medicine in a less populated area. My experience at CWFM proved to be very valuable. I especially appreciated the kind gestures of the staff there and the interest they took in making sure that our group had a positive learning experience. In addition, through interactions with patients and physicians, I became motivated to improve my conversational Spanish.”

- Emily A.

“I have wanted to be a doctor for almost as long as I can remember, I have had doubts in the last couple years concerning whether or not medicine was the right career for me. Because of HCASB I finally got confirmation that being a family practice physician is what I want to do. I grew to appreciate the camaraderie amongst residents and physicians as well as the passion that everyone working there had for medicine.

Central Washington Family Medicine seems to be the ideal clinic to work and learn in. I met some of the most amazing doctors and nurses. One physician in

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particular was a huge inspiration to me, both in his dedication to his patients and enthusiasm for medicine. As I walked into the work station where he was preparing for the coming day, I immediately felt at ease. He explained to me his routine. The night before, he prints off the list of his patients and prepares himself for the appointments he will have with them by jotting down a few notes. They serve as reminders so that he does not forget something during the course of the visit. He also explained to me that he tries to address two concerns with every patient visit; one being the reason for the appointment, and another to address some concerns they have had in the past or tests and procedures they should consider having. In this way he acts in both a curative and preventive capacity. This amazing physician shows complete dedication to his chosen profession and I only hope that I can live up to his example.

HCASB was an incredibly rewarding experience that solidified my desire to become a primary care physician. In addition, I saw up close the kind of dedication I want to show my own patients one day as well as what makes a good residency. Thanks to HCASB I can apply to medical school knowing that medicine is for me.”

- Emilie B.

“My week was exactly what I had hoped for, a chance to spend time in a community clinic shadowing doctors and residents. The residents and doctors were wonderfully willing to share their reflections on medical school, residency, family medicine and practicing in a smaller community than Seattle.”

- Amy T.

“Central Washington Family Medicine in Yakima was a fabulous site to spend the week shadowing. Since it was a teaching facility, with 19 different residents also practicing, they really took the time to explain and answer all of our questions and engage us in participation and observation. The staff of doctors, nurses, and secretaries was wonderful people who really welcomed us despite the busy flow of patients.

The majority of the people who came to the clinic were the elderly, pregnant women, and young children. It was nice because the nurses had known most of the patients for years, and that’s an awesome benefit with working in clinics- you get to build good relationships. In most cases, I thought they were very open in allowing students like ourselves to be able to watch and learn with the doctors and nurses. The most amazing experience I had was on our second day in clinic. I was shadowing a nurse in the gynecology department who was assigned to two doctors. After seeing a colopscopy, I was wowed. But what I was about to witness with the next patient was probably the most incredible of all. The patient asked a lot of questions, was blunt, felt uncomfortable having me, the student, and even the resident who was shadowing the main doctor in the room, yet was still kind and allowed us to observe. I remember her advice, ‘If it’s going to hurt, just tell the patients that, don’t try to butter it up.’

All in all, my week in Yakima was a blast. This experience reassured and in fact motivated me to keep working hard towards my goal of becoming a nurse and physical therapist. Working in a rural setting is definitely something I will consider in the future. I would love to go back to CWFM during breaks just to be able to grow, learn and see even more. Thanks for the wonderful opportunity!”

- Joann U.

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Yakima

Yakima Neighborhood Health

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“I learned in the Neighborhood Health Services clinic that cultural competency is of the utmost importance. Dr. Miller, whom I worked with, was fluent in Spanish, and thus very effective with communicating with the patients who speak little or no English.

I found the types of cases presented to be remarkable. Some children of poor Hispanic laborers were coming in with their mouths completely riddled with cavities; evidence of nearly non-existent home care. Another patient was an inmate meth addict who had been punched in the face and required complete jaw reconstruction (patient was referred to a surgeon). These sharply contrasted with routine fillings and denture fittings that were the overwhelming majority of the private clinic in west Yakima.”

- Craig H.

“When I shadowed an ARPN, we saw a patient who came in to flow up on his fasting blood test. We found that he was using two different injections from Mexico that contain potent steroids for his arthritis. Those two contain similar active ingredients therefore he was over dosing. He rejected that he used it frequently but the blood test showed that he used it often since steroid increase blood glucose level. The ARPN explained the long term effect of using the medication and offered to prescribe him a drug with similar effectiveness but less potent. From seeing this patient, I realize that as a healthcare professional you can only advise the patient.”

- Xuan-Dien H.

“I thought that language and culture would be huge barriers between the Healthcare professionals and the patients. Programs bringing translators in were available. Most of the healthcare professionals learned more about others’ languages and cultures over time. I admire the YNHS staff’s willingness to reach out to each patient no matter what ethnicity or language they may have.

I could see myself working in a nonprofit health clinic like YNHS, for I saw that there was compassion lurking in every corner. Such a place is fit for a keen listener, a critical thinker, and one who is more than eager to learn. I am overjoyed to have been given this wonderful opportunity to be with healthcare professionals, nurses specifically, as well as to carry a myriad of life-changing experiences.”

- Kristine P.

“The highly bilingual staff of YNHS is an absolute necessity for the clinic to adequately serve the communication needs of their patients. The medical professionals of YNHS seemed to effortlessly transition between using Spanish and English throughout the day. I was thoroughly impressed by their diverse communication skills.

I have always recognized the unfortunate pattern that money and good health tend to go hand and hand, but I never really physically had experienced what that meant until this trip. Our society has some very deep and complex issues when it comes to addressing the health of all of our citizens. I am appreciative that the staff at YNHS allowed me to visit for the week and view a diverse cross section of the population of Washington State. Dr. Miller, Dr. Smith and staff were infinitely patient with my constant “hovering” around the clinic while they treated patients. I am tremendougoldsly grateful that they opened the door to a new experience for me while sharing their dental expertise along the way. Thanks!!”

- Daniel S.

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HCASB 2007 Staff

Orientation Committee: (Lead) Stephanie Lin

Elie Castro Hong-Yen Chau Tram Le Andrea Ma Kim Mims Ngoc Thien Nguyen Itzi Sabanero Amy Tseng Kate Whitaker

Public Relations Committee:(Lead) Belinda Luk (Web) Joseph Noh

Elice Kim Andrea Ma Jeannie Nguyen Ngoc Thien Nguyen Amy Tseng

Steering Committee: (President) Minh-An Nguyen Nauzley Abedini Josh Boguch Tsan Lee Stephanie Lin Belinda Luk Mindy Szeto Applications Committee: (Lead) Nausley Abedini Tai Huang Howard Lin

Melody Maa Jamie Maki Stephanie Ortman Meet Shah Vincent Thuc Wu

Fundraising Committee: (Lead) Mindy Szeto Erika Korinke Melody Maa Kate Whitaker Christa Younkins

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Site Committees

Red Team: Ferry, Lincoln, Okanogan, Pend Oreille, Stevens (Lead) Nauzley Abedini

Irina Kolobova Jamie Maki Marnonette Marallag Ngoc Thien Nguyen Meet Shah Vincent Wu

Orange Team: Clark, Cowlitz, Klickitat, Skamania, Wahkiakum, Yakima, (Lead) Josh Boguch

Marnonette Marallag Ngoc (Lisa) Nguyen Irina Kolobova Meet Shah Jamie Maki Vincent Wu

Yellow Team: Clallam, Grays Harbor, Jefferson, Lewis, Mason, Pacific, Skagit, Thurston, Whatcom (Lead) Mindy Szeto

Allyne Delossantos Lisa Vu Christa Younkins

Green Team: Chelan, Douglas, Grant, Kittitas (Lead) Belinda Luk

Chester Chan Andrea Dai Tony Kim Ignatius Lau Jason Poon

Blue Team: Adams, Asotin, Benton, Columbia, Franklin, Garfield, Walla Walla, Whitman (Lead) Tsan Lee

Emilie Bunderson Cameron Chase Joseph Noh Young Park