We celebrate the WWAMI program, which turned 40 in 2011.

WWAMI is an innovative, responsive program, one whose core objective has held steady: to train primary-care physicians and other healthcare personnel from and for a five-state region — Washington, Wyoming, Alaska, Montana and Idaho. Especially in areas with too few physicians.

Throughout the fall issue, we continue to celebrate the program’s 40th anniversary by looking at the big picture: what WWAMI is doing for our communities and our world. Activities such as training and encouraging medical students. Fostering community-based research. And changing healthcare here — and in Africa! We also interviewed several community leaders in WWAMI to get their take on the program. Enjoy!

RESEARCHING BETTER CARE IN YAKIMA

When it comes to community-based medical research, Jeff Kaplan, M.D., knows exactly what he wants.

“What I’m interested in is not a research initiative in which a researcher comes into a community, completes the research and then leaves and the project falls apart,” he says. “But, rather, building sustainable models that lead to better patient care. Otherwise, the research is not helpful.”

Kaplan is a family physician at Family Medicine of Yakima and the medical director for Memorial Physicians, a primarily Yakima-based group that includes more than 70 doctors who practice a wide range of specialties in six clinics. He’s been working with Laura-Mae Baldwin, M.D., MPH ’86, Res. ’86, director of the WWAMI Region Practice and Research Network, part of the Institute of Translational Health Sciences.

Why is Kaplan interested in research? “There are a lot of things our system wants to do,” says Kaplan. Healthcare in the U.S. doesn’t work well right now, he says. It’s fragmented, inefficient and costly. Instead, he and his colleagues want to try a different model: the accountable care organization. Accountable care doesn’t measure only units of service, as traditional healthcare models do. Instead, he says, accountable care is a collaborative model that measures the quality and efficiency of medical services — and how patients respond to their care.

Tracking patient outcomes, of course, means gathering data to prove whether a treatment is effective – in a word, research. What’s different about this kind of research is that it’s not primarily based at a college or university. Instead, it’s conducted within a community.

Kaplan, Baldwin, Beverly Green, M.D., MPH ’85, of the Group Health Research Institute, and several other practitioners are applying for a grant to research a web-based blood pressure treatment model for populations normally resistant to treatment. If funded, the grant will help the researchers translate the protocol, tested at Group Health in Seattle, to community-based medical programs. Data will be collected and assessed by multiple clinics in Yakima, Seattle, and Pocatello, Idaho.

If the project is successful — as it was at Group Health — patients’ lives will be improved. And Kaplan will know he’s on the right track.

“People are hungering to improve care,” Kaplan says, and community-based research is a tool that can facilitate that improvement. “I’m excited about building these types of relationships.”

Jeff Kaplan, M.D., is helping lead community-based medical research in the Yakima area — all in pursuit of better care for patients.

ORIGINAL INSTRUCTIONS

“We’re in a generation in which people are likely to outlive their children,” says Karina L. Walters, Ph.D. She’s talking about the Choctaw Nation of Oklahoma — her tribe.

Walters, the director of the Indigenous Wellness Research Institute at the University of Washington and a collaborator with the UW’s Institute of Translational Health Sciences (ITHS), is concerned; 70 percent of her people are obese or seriously overweight.

Think of the Trail of Tears, walked by the Choctaw. “Our ancestors did not die for us to be eating ourselves to death,” she says. In fact, the ancestors — in the form of “original instructions” — may provide the key to fighting today’s obesity epidemic.

Original instructions are, essentially, a tribe’s traditional customs and protocols. Walters says they are a powerful tool in working with tribes on health and wellness. “Part of our task is to bring Western tools to the table and combine that with the tribe’s knowledge to come up with a prevention program or an intervention,” she says.

That’s why she’s having the Choctaw re-walk the Trail of Tears to fight obesity.

Tribal leaders, she says, had come to her for a consultation on rising obesity. They had spent millions on health centers and clinics, and it wasn’t helping. Instead of telling people what not to do, thought Walters, what if we motivate the community to act?

To that end, she and the tribe have designed a pilot program, one slated to begin in 2012. Participants will re-map the Trail of Tears. They will also consider some thoughtful questions about health and wellness: what did the ancestors do so they could survive? What are the original instructions with regard to their relationship with medicine? What did the ancestors hope for their health?

In addition to connecting people to the past, Walters plans to connect them to the future. For instance, youth ambassadors will document the walk with video and social media, and they’ll help researchers and elders come up with a new vision for fighting obesity for the next seven generations.

It’s this type of creative problem-solving that Walters and her colleagues will bring to their work with the ITHS’s Tribal Community Outreach & Research Translation Core.

“I think it’ll make both our groups incredibly stronger,” says Walters.

WWAMI Notables

The Road to Browning, Montana

A group of first-year Montana WWAMI students and faculty visit the Blackfeet reservation

As we drove into the small town of Browning, Mont., on the Blackfeet Reservation, the sun faded behind the snowy peaks of Glacier National Park. The bitter west wind pressed into our cars, threatening to blow us from the road. Though only five hours from our home in Bozeman, the piercing cold told us that we were someplace very different.

That evening, it became apparent that Browning’s weather was not the only difference we would encounter. We first met with Neil Sun Rhodes, M.D., a family practice doctor with the Indian Health Service (IHS). He shared his experiences — providing care with few resources — emphasizing its challenges as well as its opportunities.

For example, there are no cardiologists on the reservation. So, each month, a cardiologist makes a four-hour round-trip journey from Great Falls, Mont., to see patients in Browning. This scarcity of medical resources reemphasizes the importance of primary care in diagnosing and reducing cardiovascular risk.

Dr. Sun Rhodes says that the primary-care physicians in Browning have risen to challenges like these, providing excellent care despite limited resources. Fortunately, the Blackfeet Reservation’s location, adjacent to a famed national park, attracts many outdoorsy IHS physicians who tend to stay longer than those who work on more isolated reservations.

The next morning, we went out into the community. In the month prior to the trip, we had coordinated massive clothing and children’s book drives in the Bozeman community. Using drop-boxes at prominent local retailers and community centers, we collected enough donations to fill three trucks, three SUVs and a trailer. In Browning, we delivered the books to school libraries and the clothes to a distribution center.

Then we split up and went to the elementary, middle and high schools to talk about health professions. We also gave lessons in anatomy and physiology using cadaver lungs and hearts. The opportunity to meet such excited and engaged students was the highlight of the trip for many of us.

For lunch, we used food donations from Bozeman to prepare a large batch of chili, salad and bread for Browning’s homeless. Community members took shelter from the cold in the basement of the De La Salle Church, enjoying a hot meal, receiving flu shots administered by local nurses, and choosing from a collection of donated coats.

In the afternoon, we met with another doctor, Mary DesRosier, M.D. One of the principal organizers of our service-learning trip, Dr. DesRosier grew up in Browning and has been a family physician there for several decades.

In the afternoon, she took us to the Browning Community Hospital and showed us around its 28-bed facilities. Amazingly, its ER receives nearly 30,000 annual visits and is covered by several ER and family physicians. Dr. DesRosier described family physicians who not only did ob/gyn and emergency care, but also received training to perform C-sections and appendectomies. It was an excellent example of doctors who use the full scope of their skills and practice.

In the evening, we met with a tribal elder who discussed Blackfeet culture and life in Browning. As he spoke, we reflected on how lucky we were to be welcomed into this community, learn about its people, and have the opportunity to give something back. The next day, as we drove back to the warmer temperatures of Bozeman, our memories of Browning reminded us of what a privilege it is to be a physician-in-training.

When we visited with schoolchildren in Browning (part of the Blackfeet Reservation), we brought props to interest the kids in anatomy. Michael Barton (top) used a classic plastic skeleton. Raima Amin and Justin Shinn (bottom) used a circulatory-system chart. For us, interacting with the kids was the best part of our trip to the reservation.

The Experience of a Lifetime

A Letter From Dr. Abid

I read with great interest the article on WWAMI in the most recent edition of UW Medicine. A flood of old memories came back to me. I graduated from the psychiatry residency training program in 1981. I was interested in cross-cultural psychiatry and applied to the WWAMI program thinking I would be going to blue Hawaii to study the Native culture there. Imagine my surprise when they told me I’d be spending six months in Alaska!

As it turned out, it was the experience of a lifetime. I was extremely fortunate to work on the forensic unit at Alaska State Psychiatric Hospital, at the Native Indian Health Service, and at the local hospital in Anchorage: three very different and unique patient care experiences that have served me well over my career.

The icing on the cake was being the general medical officer/physician resident for the Pribilof Islands for two weeks. They were a bit amused when I told them my specialty, psychiatry! But as I found out, they had plenty of mental health issues to keep me busy — as well as seal bites, hypertension, diabetes and the like. I remember well the beautiful people that worked in the clinic on the Pribilofs. They enjoyed watching me try muktuk ( whale fat) for the very first and last time!! The artwork was fabulous. I treasure the Native baskets made in Alaska. The staff knew I was homesick at times, and they helped me contact my fiancée in the lower 48 on the only satellite phone on the island!

I saw the famous Iditarod Trail Sled Dog Race end in Nome, and I have a photo I treasure of a visit from a local moose parked in my driveway on the University of Alaska campus.

As one of the first DOs to complete a residency at the UW, I am very grateful for all that I learned at the UW, the experience of living in Seattle, the lifelong friends I made, and the long-term impact that single decision had on my career. While I was a resident, computers barely existed, and Microsoft was just a start-up. How did I miss that one?!

Nicholas Abid, D.O., Res. ’82, MBA, FACN
Medical Director
WellCare Inc. Health Plans