“We represent more than ourselves.”

“We represent more than ourselves.” My preceptor's words reminded me of partially why I have been so determined to get this internship.

During P1 year, I was very excited to learn about Public Health Service pharmacists through a class project assigned by Dr. Gaither. During P2 year, I was assigned to an IHS site in Arizona but did not end up going due to personal circumstances. During P3 year, I reapplied to JRCOSTEP, because I knew it would be an experience I would not forget.

A notion of admiration and gratitude welled up when my preceptor discussed with me the expectations bestowed on a Commissioned Corps officer. Unlike civil service pharmacists who are evaluated on conduct and performance, Commissioned Corps pharmacists are evaluated on character and performance. We then discussed the meaning of character, which can be summed up as:

Character: /kærɪktər/ noun; upholding one's integrity and doing what is right even when no one is around, even under pressure, and even when no one else is doing it

The Commissioned Corps pharmacists are evaluated differently from other pharmacists because they represent more than themselves and more than the pharmacy profession. They are working at the front lines of health promotion for our country, providing services whenever and wherever necessary. Victims of the earthquake in Haiti, prisoners isolated from society, and Native Americans on reservations have all benefited from their contributions. Their willingness to take on these responsibilities is definitely worth noting.

“This is why I want to be here,” I told him.

“We’re happy to have you,” he replied.

On a side note...

At the local Indian Pueblo Cultural Center, I came upon this quote...

I’m continuously fascinated by the rich culture of the Native American people, exemplified by their pottery, jewelry, dances... all of which I had the pleasure of witnessing this weekend. Below is a snapshot of the "Buffalo Dance" by the Cellicion Traditional Zuni Dancers.

Room One

What enables Albuquerque Indian Health Center (AIHC) pharmacists to provide great pharmaceutical care?

This is what I have observed in the past two weeks:

1. Three consultation rooms!

“Joe Smith in Room 1!” announces an intern into a microphone that projects to the waiting area. But before calling out the name, he/she must make sure that: (1) the medications are matched to the right patient; (2) he/she knows how to counsel on those prescriptions; and (3) he/she is prepared to probe for new information. This ensures that the prescription verification process is carried out from drop-off to pickup.

Then the intern and the patient have a one-on-one conversation about the patient’s medications and other related issues in the privacy and protection of an enclosed counseling room.

This takes up too much time, you may say, but keep in mind that there are three counseling rooms. Also, a pharmacist pointed out to me that one of the biggest mistakes in counseling is to tell a patient things he/she already knows - this would waste both the pharmacist and the patient’s time. Instead, fill in any gaps of knowledge and try to attain relevant information that is unavailable in the patient chart.

2. Access to electronic health record

All the clinics at AIHC use one electronic health record system. Pharmacists can access a patient’s lab results or read physician/nursing notes when deciding whether a prescription is the optimal treatment. This empowers the AIHC pharmacists with a tool that many community pharmacists lack.

A different point of view…

The way a doctor or a nurse would use information in the electronic health record is drastically different from the way a pharmacist would due to their different roles in the patient care process. AIHC's computer system allows the health professionals to customize the appearance and organization of patient information according to the needs of the profession.

3. Culture of AIHC

The health professional team at AIHC provides a nurturing environment for pharmacists to do more. Physicians automatically refer suitable patients to anticoagulation, tobacco cessation, emergency contraception, and dyslipidemia programs run by on-site pharmacists. In this way, pharmacists are bestowed the task of managing many of the chronic conditions for patients, which frees up time for doctors to diagnose and to treat acute conditions. This collaboration is an effective use of the expertise of both doctors and pharmacists.

"Red or Green?"

“So… where is a good place to get green chili?” My casual question started a fervent discussion with episodes of laughter, as everyone drools over descriptions of his/her own favorite preparation (which are all different) of this New Mexican staple.

So far, I have tried green chili (the whole pepper), green chili salsa from a local store, and breakfast burritos with red and green chili sauce on the side. “Red or green?” is a common question asked in New Mexican restaurants where chili can be added to almost everything, from burritos to enchiladas to pizzas and even to eggs! “Christmas” is the local lingo for wanting both.

Adobe

I also adore the adobe houses on the residential streets of Albuquerque. The Pueblo Indians favored using adobe to build shelters due to its ability to keep the interior cool during the day and warm during the night. I like looking at them, and they've been my incentive to jog at dusk every other night.

Are you sitting here?

Are you sitting here?

This is the literal translation of a Pueblo Keresan phrase that serves the same social function as the American “hello.” It is, fittingly, my greeting to you all in my first entry about being a JRCOSTEP participant at Albuquerque Indian Health Center, a facility within the federal agency Indian Health Service (IHS). For those of you who are less familiar with JRCOSTEP and Indian Health Service, this entry serves as an introduction to my upcoming month in New Mexico.

What is JRCOSTEP?

JRCOSTEP stands for Junior Commissioned Officer Student Training and Extern Program. It offers health professional students the opportunity to work alongside the U.S. Public Health Service (PHS) Commissioned Corps officers at agencies like Indian Health Service, Food and Drug Administration, and Federal Bureau of Prisons. The PHS Commissioned Corps aim to promote the health and safety of our nation through disease prevention, emergency response, scientific research, service to disadvantaged populations, etc.

What is Indian Health Service?

IHS is an agency within the Department of Health and Human Services. It was established in 1955 to improve the quality of subsidized health care services entitled to Native Americans and Alaskan natives, many of whom were inflicted by tuberculosis and other infectious diseases. Since then, the health status of Native Americans has improved significantly. Today, IHS serves approximately 1.9 million Native Americans nationwide.

Most importantly, why would a pharmacist or pharmacy student want to work for Indian Health Service?

IHS pharmacists have established an exemplary model for pharmaceutical care. In fact, some credit IHS as the pioneer of this concept, which has helped to improve the quality of patient care as well as to raise the level of job satisfaction for pharmacists. We’ll see if I can attest to this as my month goes by.

On a more personal level, it’s great to interact with Native Americans, whose culture we hear so much about but experience so little. I had learned the greeting above from a newly-acquainted Indian coworker who speaks Keres. Keres, Tiwa, Tewa, as well as Towa are languages spoken by the Pueblo Indians in the Southwest. I look forward to being enriched professionally and culturally during my stay here.