The Tribe’s Health Department partnered with the Florida State University (FSU) College of Medicine in 2000 to have students work alongside physicians in clinics tribalwide. Starting in the fall, medical students from Nova Southeastern University (NSU) College of Osteopathic Medicine will also learn in the clinics.
The FSU program allows two students between their first and second year of medical school to work in the clinics for three weeks. The NSU program offers third- and fourth-year medical students the chance to work in the clinics for two months.
“They get a sense of a community practice,” said Dr. Christopher Mavroides, the Tribe’s chief medical officer. “The idea is to get students to go into more rural areas.”
Nursing students nearing graduation from Florida Atlantic University (FAU) have worked rotations at Tribal clinics for at least 10 years. Mavroides looks at the students as potential employees; Melanie Mello, a nurse practitioner in the Brighton clinic, came out of the FAU program.
Practicing medicine for the Tribe requires more than attending to medical needs; it is a medical home, Mavroides said.
The clinics have case workers, nutritionists, fitness programs and nursing care, and they offer referrals to specialists, transportation arrangements and house calls.
“We are a full-service department,” Mavroides said.
Pediatrician Dr. Ashley Bayer, an NSU graduate, initiated the partnership with the NSU program, which requires students to complete a rotation in a rural area. The Health Department will take one or two students at a time, and the program will run eight months during the year.
“The students will get exposure to all the reservations, including Hollywood, so they can see the contrast between the populations,” said Bayer, a member of the Mohegan Tribe in Connecticut. “The rural reservations have to have more flexible treatment plans because we can’t always get the medication or the transportation. You have to think outside of the box and maintain the standard of care.”
The Tribe benefits from the program by increasing awareness of the Health Department to the larger medical community. It also brings health care professionals to a group of people with unique needs.
“It’s a good opportunity for the providers and the students,” said Pauline Good, ARNP/nurse practitioner in Hollywood. “They add to our knowledge and keep us up to date.”
Cultural awareness is an important component of the program.
Students learn to respect Tribal traditions, which may affect medical treatment.
“We don’t want a new young doctor to tell a parent of a newborn baby to take off the four moon ceremony beaded necklace and bracelet because it’s a choking hazard,” Bayer said. “We have to be culturally sensitive to the purpose.”
Instead of advising parents to remove the necklace, she advises them to count the number of beads so they will know if any are swallowed.
“Culture is integrated into the program by having the students learn to listen to the patient and not just go straight to their medical training,” Mavroides said. “For any treatment to be successful, the patient has to buy into it.”
Seniors and elders who see numerous specialists are prescribed several medications. Mavroides knows they don’t take them all, so students and physicians need to determine what is acceptable to them and then create a plan to treat the most important ailments.
“In other communities, people are more amenable to taking multiple medical regimens,” Mavroides said. “They are more in tune with Western medicine. Some elders in the Tribe are leery of taking a lot of medicine, so you have to minimize that as best you can.”
The Health Department has a staff of five doctors – three are internists, one is a family practice physician and Bayer is the only pediatrician – and seven nurse practitioners tribalwide.
The FSU College of Medicine aims to develop physicians who will serve rural, elder, minority and underserved populations. The school has campuses in Daytona Beach, Fort Pierce, Immokalee, Marianna, Orlando, Pensacola, Sarasota, and Thomasville, Ga. FSU medical student Jason Lesnick worked with Mavroides in May and looked forward to gaining experience with patients.
“I feel it’s important for physicians to try to help underserved people, and rural populations are very underserved,” Lesnick said. “The most common things we see are obesity, diabetes and hypertension. We need a lot more preventative medicine to keep it from affecting the next generation.”
Mavroides thinks the experience will help students decide on their future careers with more knowledge. He said that patients have the option of allowing the medical students into the examination rooms.
“Well over 90 percent of them are cooperative,” Mavroides said. “They treat the students great, are very open and wish them well.”
Bayer said working for the Tribe is different than working off the reservation.
“The Tribe never ceases to amaze me in their culture and community,” she said. “They demonstrate a very supportive network with each other and make efforts to maintain the culture through the generations to preserve it. It’s an honor to work for them.”