During the last day of our trip to South Dakota’s Rosebud Reservation, I had the opportunity to observe and learn from a physician working in the women’s health clinic. The clinic provides a wide range of services to women throughout the area, including perinatal and family planning resources.

The main office of the clinic is covered with posters, brochures, and photographs to provide women with information about reproductive health. Although many of the materials were not culturally specific, several materials included graphics that were. For example, the hospital is becoming more nursing-friendly in accordance with Michelle Obama’s 2011 initiatives to promote breastfeeding. Several of the materials included Native American women breastfeeding their infants as well as information about the benefits of breastfeeding. Rosebud Indian Health Service is also instituting a nursing center at the hospital.

The front desk offers male condoms and female condoms available at no cost to patients. Despite these resources, we were told that sex education and safe sex are not widely practiced on the reservation. We also learned from him that sexually transmitted diseases are common among patients there.

During several patient visits, the doctor explained the birth delivery process to women who had a clear lack of knowledge. As I learned throughout the health-disparities course and during my observations at the emergency medicine department, alcoholism is a major problem on the reservation - even among pregnant women. Later in the day, I met several young people who were born with fetal alcohol syndrome and grew up on the reservation.

Amaya Cotton-Caballero is a senior at Stanford majoring in human biology. She recently visited the Rosebud Reservation in South Dakota as part of her Rural and American Indian Health Disparities class. The goal there was to learn about socioeconomic determinants of health through visits with various Indian Health Centers, community members, and tribal educational institutions. Cotto-Caballero is interested in public health and medicine.

Previously: Lessons from a reservation: South Dakota trip sheds light on a life in rural medicine and Lessons from a reservation: Visit to emergency department shows patient care challenges

South Dakota’s Rosebud Hospital provides care to patients both on Rosebud Reservation and in surrounding areas. My recent visit to the emergency medicine department there gave me a glimpse of the successes and challenges faced by the Indian Health Service (IHS). Although IHS overcomes many hurdles to providing care, limited funding also presents it with significant challenges - and the many social determinants of health also contribute to health disparities on the reservation.

For example, because of scant resources, the hospital does not offer rapid strep testing and, as a result, strep throat was not definitively diagnosed in one patient when I was there. A physician treated a patient with a history of high blood pressure, depression, and diabetes - major health challenges on the reservation. Another resident of Rosebud noted that she was twenty-one years old and a mother of three before she received sex education.

Although I saw no alcohol-related accidents during my time there, a physician discussed the many visits resulting from accidents associated with alcohol consumption. He also discussed how alcohol use leads to motor vehicle accidents and is associated with sexual violence on the reservation.

Later in the week, two medical students observed how doctors efficiently cared for patients who were in a methamphetamine lab accident on the reservation. According to Ira Salom, MD, the chief medical officer of the IHS serving the Rosebud Sioux Tribe, methamphetamine use has also become a major problem on the reservation.

Several doctors also noted that IHS offers financial support to medical students interested in working with the service after graduation.

Amaya Cotton-Caballero is a senior at Stanford majoring in human biology. She recently visited the Rosebud Reservation in South Dakota as part of her Rural and American Indian Health Disparities class. The goal there was to learn about socioeconomic determinants of health through visits with various Indian Health Centers, community members, and tribal educational institutions. Cotto-Caballero is interested in public health and medicine.

Previously: Lessons from a reservation: South Dakota trip sheds light on a life in rural medicine