The Dartmouth Center for Health Care Delivery Science

Dartmouth and the Indian Health Service
Origins

Roots of a Relationship

According to former Dartmouth Medical School dean Jim Strickler, the principle reason behind forming a relationship with the Indian Health Service (IHS) was to expose Dartmouth’s medical students to a more diverse patient population.

Compared to schools in urban and multi-ethnic settings, Dartmouth’s students worked with a relatively homogenous patient pool. Strickler saw the lack of diversity as a problem, since most students would go on to work far from Dartmouth’s New Hampshire campus. He looked for opportunities to create rotations in other parts of the country to expose students to different types of patients and health issues.

A physician on the medical school faculty, Dr. Dean Seibert, was the primary mover in developing the relationship with the IHS. Seibert had become involved with the IHS as a consultant on a project called STARPAC (Space Technology Applied to Rural Papago Advanced Health Care). This initiative, between NASA and the Indian Health Service, involved closed-circuit television as a means for delivering health care. The ability to communicate between clinics electronically could be very useful on reservations, especially in remote areas that didn’t have on-site physicians. The technology was being tested with the hope it would be suitable for delivering medical care to astronauts in space.

While working as a consultant, Seibert picked up two hitchhikers near Flagstaff, Arizona, and learned that an Indian Health Service hospital was located nearby in Tuba City, on the Navajo reservation. At the hospital, he met Dartmouth alumnus John Porvaznik, a surgeon and director of the hospital. Aware of Jim Strickler’s desire for more diverse experiences in the medical school curriculum, Seibert talked with Porvaznik about the possibility of creating a relationship between Dartmouth Medical School (now the Geisel School of Medicine at Dartmouth) and the IHS. Seibert and his family spent sabbatical time working for three months with community health representatives (CHR) on the reservation. Although the main focus was to develop a gastro-enteritis control program, time spent there also worked to overcome cultural and communication barriers to providing good medical care.

Seibert and colleague Dr. Frank Hale of the Department of Community and Family Medicine eventually established a six-week opportunity for medical students to fulfill their required training in Primary Care. One of the unique aspects of this rotation is making home visits with CHRs in order to understand how the home environment affects the health of the Navajo family. Dartmouth’s Family Medicine Rotation in Tuba City began in 1975 and is still going strong nearly four decades later.