I spent my spring break on the Rosebud Reservation, in South Dakota, as part of a joint Stanford undergraduate and medical school class studying health disparities in a rural, reservation setting. For two days, I shadowed doctors and other health-care professionals at the local hospital, which is run by the Indian Health Service (IHS).

I myself am an enrolled Osage from the Osage reservation in Oklahoma. I’m a pre-medical student, and one of the reasons I want to go into medicine is to improve health in Indian Country. I knew the patient’s side of the IHS already, but I wanted to get a perspective from the provider’s side, which made this trip a no-brainer.

Healthcare at the hospital is free – paid for through the U.S. Federal Government’s discretionary budget – because of a long history of treaties in which Indian tribes exchanged land with the United States in return for food, education, and health care.

Being familiar with Stanford Hospital, I was amazed by the breadth of responsibility that IHS doctors had. The family physician I shadowed ran an outpatient clinic, managed the medical ward (which it seemed she took calls for almost every night), served as first assistant in some surgeries, and was about to also take shifts in the emergency room.

I wondered about the wisdom of this until the doctor reminded me that she was trained for everything she did. The legal pressure in mainstream America conditioned me into a mindset of medical specialization, but on a rural reservation there are no specialists. And, it soon dawned on me that my doctor’s wide scope of practice developed out of necessity. Poor equipment, an overload of seriously ill patients, and a lack of access to higher-level care demanded that the already short-staffed IHS doctors go above and beyond what is normally required.

When I asked the nurses how often they had to ‘MacGyver’ equipment, the answer was not just “sometimes” or “often” – ad hoc solutions were a way of life.

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