Week 1 at Wagner
Sunday I arrived to Wagner and got all of my stuff unpacked into the patient room at the hospital I would be staying in. I was impressed by how new the facilities were and the warm welcome I received from the staff here. It took me a little bit to get used to the idea of sleeping in a hospital bed, but I found that being able to use the controls to help me get out of bed has its perks.

Monday was a holiday, so I spent some time exploring the Wagner community and working on my research project. Tuesday I started work in the Emergency Department with Abdul Qazi MD and in the clinic with Jordan Weber PA, Mel Otte CNP, Kristi Koupal RN. It was a great experience for me because I was able to move between the hospital and the clinic to see patients in both settings. I also went on a ride along in the ambulance with a transfer patient for the first time.

Tuesday night I experienced my first wakeup call in the middle of the night for an emergency room patient. It was interesting getting to experience what being on call really feels like. I was able to experience a very unique clinic presentation with Dr. Qazi that I will likely tell stories about for the rest of my life.

Wednesday we had training for our community project. I drove over to Winner through small towns like Burke, Gregory, and Dallas that all had their own local color. It was fun to experience these towns after developing friendships with people from these towns. On my way back to Wagner, I stopped at the Randall Hills Country Club in Pickstown to catch a quick round of 9 holes. After I got done golfing, I stopped into the clubhouse to meet some of the locals and met the former Armour postmaster Dennis Walker, who was the ring-bearer at my grandmother Darlene Martinec’s wedding. My mother, Deb (Martinec) Bollinger originally grew up in Lake Andes just ten minutes from Wagner. I finished the night by going to youth group at Boom’s restaurant. The youth group was led by the owner of the Boom’s, Scott Alderink. It was a great opportunity to meet with some of the youth in the community.

Thursday and Friday, I continued to work in the emergency department and the clinic. It has been crazy to see how in rural communities the number of patients coming in can drastically change from one minute to another. I quickly learned that the taboo words at the nursing station such as “quiet” or “slow” are not to be used at any time for fear of a rapid influx of patients. At times where it becomes very busy, the nursing staff does an amazing job of making sure that our patients are taken care of.

Saturday I built an 8-foot picnic table for my girlfriend Katie Barnett and her family with her dad Jerry. It was a lot of fun to do carpentry with him. After we got done building the table, Jerry, Caleb (Katie’s brother), and I went out to the golf course for a round of golf at sunset in Pickstown. I spent Sunday finishing up things on the table with Katie and her dad. I went for a run in the afternoon. I have been running quite a bit since arriving in Wagner. There is a walking path that goes around the beautiful little lake in town, which is a nice change of scenery when out for a jog or walk. The lake is great for picnics as well.  I worked at the hospital with Katie for a few hours on Sunday night before going to bed because she was working the night shift as a patient care technician.

Week 1 was an absolutely phenomenal experience for me in Wagner! The staff at Wagner Community Memorial Hospital has welcomed me with open arms. The wonderful ladies in the kitchen tempt me daily with their wonderful desserts. I am gradually beginning to understand the unique challenges that a rural hospital such as Wagner faces in the ever-changing healthcare field. Our CEO Bryan Slaba has been a huge help in getting me settled in to the facilities here. Did I mention he took my mom to prom in Lake Andes when they were in high school?…. (Crazy right???).  I am looking forward to continuing my work with the people in Wagner.

Week 2
Monday started out with another typical day balancing clinic and the hospital. I worked with Dr. Qazi in the Emergency Department throughout the morning. We weren’t too busy so Dr. Qazi and I talked about a whole range of things from stethoscopes, to investing, and even weddings and rings. Everyone thought it was pretty funny to listen to Dr. Qazi. We also went through a lot of the procedural aspects of the patient history and physical exam. I spent a big chunk of the day reviewing some of the various physical exams to do with patients. Monday was also Max’s first day in Wagner. I gave him a brief tour through the town and showed him some of the key landmarks.

Tuesday morning Max and I started putting together our plans for the Community Health Needs Assessment. We went through some of the documents to make sure we were doing everything the right way. Then we brainstormed a few of the individual community members that we wanted to interview. We set up a few interviews for later in the week. I spent time in the clinic with Jordan, Melody, and Lindsey in the clinic in the afternoon. I had a lot of fun sharing stories about crashing on bikes with a young boy who came into the clinic for strep.

Wednesday morning I was in Physical Therapy with Joe Sees. He had a pretty busy schedule. Most of his patients were recovering orthopedic surgery operations. Joe was doing exercises with many of the patients working on improving strength and range of motion. Though the majority of the patients I worked with were recovering from surgery, there was also a young girl doing therapy to improve motor function after impairment from brain cancer. The facilities for the physical therapy at the hospital are excellent. They also make the room available as a 24/7 workout room.

Max and I attended the Wagner Rotary Club meeting for lunch. It was great to see what the Rotary Club is involved in and how they are working to improve the community. The business environment is very active in the town of Wagner. After the meeting Max and I met with Jeff Doom, who is the owner of Wagner Building Supply. We went through the worksite interview with him and spoke with him about various aspects of the community. After our interview, Jeff took us out to his house and showed us the housing development he was working on around his house. He has kayaks and canoes on a manmade lake that is now connected to the Wagner Lake in town.

 We then walked across a bridge Jeff had built and up the hill to his brother Todd and his wife Amy Doom’s house. Amy is a very active member in the Wagner community, and to provide her with one title does not do justice to the amount of things she does for the community. We went through the community interview and then spoke at length with Amy about many of the aspects of public health that are being addressed by the community of Wagner. She spoke a lot about the effort to bring fresh food to the community as well as a bike path that will greatly benefit the community.

Amy was also able to set up a meeting with Vince Two Eagles. Vince gave us a historical perspective of the Native American community in Wagner. He was able to share his experiences in with the Indian Health Services and their interaction with the Wagner Community Memorial Hospital. Speaking with Vince helped us a lot to understand the culture in Wagner and the efforts being made to improve the culture.

Thursday morning I started with Dr. Pinter in the ER. Around 10 Dr. Johnson, who is an orthopedic surgeon from Yankton, came into the clinic. Dr. Johnson arrived with two nurses and a physician assistant. One of his patients did not show up to his appointment, which seems to be a problem at times for the Wagner clinic. One of the patients was a man with a suspected rotator cuff tear that was scheduled for an MRI and the other was a man with trochanteric bursitis and radiculopathy.

Thursday afternoon I worked with Jordan and Lindsey in the clinic. Max and I interviewed Scott and Julie Alderink, the owners of Boom’s. We talked about food service in the community of Vermillion. We also spoke with Julie about physical activity, including a 5k color run that was just done in Wagner. To finish our interview we had a little ice cream.

Friday morning, I spent time in the lab with Leslie Martinez. She showed me all of the machines that they have available in the Wagner hospital.  She also explained the sensitivity of some of the equipment that we have. Leslie spoke about how the laboratory technicians must also be on call during nights and weekends, much in the same way that the providers are.

Friday afternoon we had an interview with Craig Noteboom at the Indian Health Services building. Craig is a nurse at IHS, and he was able to provide us some valuable insight into the delivery of care at the IHS facility. He spoke at great length about the efforts towards diabetes prevention and treatment that are going on. He also helped us to understand the funding structure of the IHS.

Friday night, Max and I volunteered at the Good Samaritan Nursing Home Carnival. It is a community event that is well attended by both people from Wagner and family members from outside the state. We first assisted residents getting in and out of Classic Cruisers Car Club cars. I was able to ride in a 1924 Ford Model T with one of the residents from the nursing home that told stories about the town all along as we went.  Later on in the carnival, Max and I worked the bouncy pit. Thankfully we made it the whole carnival without any broken bones, bloody noses, or crying children. To close the night, we went with Michelle Juffer, the director of the nursing home, on a night boat ride in Pickstown. We shared stories with a few of the people from the community and enjoyed how peaceful the Missouri river was.

Saturday Max and I went to Yankton for the Rockin’ Ribfest. We tried out some freshly barbequed food and walked around to various food venues. We made it back to Wagner just in time for the weather service to issue a tornado watch for the rest of the day. Delmont, a small town 25 minutes from Wagner, was recently devastated by a tornado and so all eyes were to the sky for this one. Luckily there weren’t any tornadoes in the area this time.

Sunday was a busy day in the emergency department. We had a busy time in the early afternoon and also late in the night. When I wasn’t taking call and coming in to the emergency department, I was helping my girlfriend Katie to prepare for the Miss SD pageant, which is now less than two weeks away.

Week 2 provided Max and I a lot better perspective of Wagner and the healthcare services offered in Wagner. We learned some of the ways in which Wagner community members are trying to make improvements, as well as some of the areas that still need to be addressed. Many of the community leaders we spoke with are making significant efforts to address the health needs of the Wagner.

The Wagner Health Consortium is one group that is seeking to make these improvements. They are addressing all aspects of public health and working to develop ways to promote their efforts in the community. They have even established a social media presence that to me shows a great start to adapting to the trends of younger generations to promote public health: www.facebook.com/WagnerAreaHealthAndWellnessConsortium. The success of the consortium in bringing together community members around this cause is very encouraging for me when considering the future public health for Wagner.

Week 3
This week started with working both in the emergency room and the clinic. We started out busy working with patients that came in from a car accident. Luckily no one was severely injured, but it was very informative to go through the protocol to make sure that everyone was going to be all right.

Tuesday morning I spent some more time with Joe Sees in the Physical Therapy and Rehab center. I was able to work with patients doing their postoperative treatment. It was great to see the ways that damage or deficits in one area of the body can cause pain in other areas. Joe is very good at working with patients to strengthen all areas of weakness following surgery.

Tuesday afternoon I had the pleasure of meeting one of the elderly ladies living in the assisted living building next to the hospital. It was great to see the facilities that they have available for community members in close proximity to the hospital. This facility provides easy access for the residents to get to their providers at the clinic. It was an extra special visit as she used to travel the country with my grandparents when they were younger.

Wednesday morning I practiced giving intramuscular injections with an orange. I did it with a variety of different needles and syringes to really understand the different ways the needles and syringes felt. The orange wasn’t too happy with me afterward, but the backlash from an orange is definitely better than that of an unhappy patient. We unfortunately were unable to meet with the community members for our scheduled interviews. So we made a stop to the Cake Lady in town and grabbed some quick dessert before lunch.

During lunch we attended the Wagner Area Health and Wellness Consortium meeting at Boom’s. We were able to hear from a representative from the SDSU Extension. They are working on setting up programs in communities on reservations throughout the state to address community health needs. It was also interesting to hear that South Dakota is currently 50th in the nation for fruit and vegetable availability. This program looks to have promise for improving the public health atmosphere in these communities.

Wednesday afternoon we met with Pat Breen from the Wagner Area Boys and Girls Club. The Boys and Girls club has been doing an incredible job of pooling resources to serve the health needs of the children within Wagner and the surrounding communities. They offer programs for children in the community at the club and also coordinate summer athletic programming for children to help them in remaining active. They also help to educate children on aspects of personal health that will prove vital to these children as they grow into adulthood.

Thursday I worked with Dr. Brent Adams, an orthopedic surgeon from Yankton. I was able to view a few surgeries in the operating room in Wagner. It was interesting to see the ways that doing surgery in a rural hospital such as Wagner differed from those done at a surgical hospital. We also saw a large number of patients in the clinic. Many of the patients we saw needed further diagnostic testing or surgery, some of which could be done in Wagner, while others needed to be done in Yankton.

After Dr. Adams was done, I spent some time talking with Dr. Byron Nielsen, a nephrologist from Yankton. We spoke about how he chose to go into his residency and what the field of nephrology has offered him. Unfortunately, most of his patients had already been in the clinic by the time I was done.

Friday morning I went over to the nursing home. Director Michelle Juffer gave me an introduction to the financial background of the Good Samaritan Society. I then spent the rest of my time following the nursing staff. It was very interesting to see the unique challenges that providers face in a nursing home setting. The challenge of losing patients on a more frequent basis in this setting would definitely be something that would be hard to get used to, especially as close as the staff works with each patient in the home. Karen Olson, a nurse at the nursing home, turned out to be a classmate of my uncle Ken’s from high school. I had a lot of fun learning from her and hearing her stories.

Friday afternoon I spent out in the community. I visited an elderly couple at the assisted living home with Katie. After that I went out and enjoyed the wonderful day in Wagner. It was nice to get out and get some sunshine.

Saturday morning I ran in the 5th Annual Best Dam 5k run at the Fort Randall Dam in Pickstown. It was a wonderful event and somehow I managed to place 5th in the run. Richard Langdeau Jr. won the race with a time around 16 minutes! He was so fast, and within the first mile he already had about a half mile on me, or so it seemed. It was a great way to bring together members of the community to get out and get some exercise, and the weather could not have been better.

The rest of the weekend, I spent time with Katie and helped her get ready to leave for the Miss SD pageant. It is crazy to think that my time in Wagner is almost over. The experiences and the people in Wagner have been absolutely incredible. I could not have asked for a better time with the community and the hospital here. I’m looking forward to my last week working here. It will definitely be tough to leave the people and places I have come to call home this last month.

Week 4
Week 4 was my last week in Wagner. We started the week with our end of the program presentation. A lively audience came to hear how our experience was, and it was really fun to recount everything that happened during our time in Wagner.

After our presentation, Max and I took a road trip down to the St. Paul’s Mission Cathedral in Marty. The campus around the cathedral and the architecture were incredibly beautiful. We talked at length with one of the church caretakers to understand some of the history of the church. We then stopped at the Fort Randall Casino. We made a lap through the facility and resisted the urge to sit down and test our luck at winning it big. We then returned to Wagner.

We headed out to Jeff Doom’s house and took the kayaks and paddle boards out for a spin. We laid down on the paddleboards so that we could get over to the Wagner Lake. It is a beautiful area for the community around the lake. We ended our night with ice cream at Boom’s.

Tuesday, I worked with Dr. Qazi. It was a busy morning as we had a lot of patients in the hospital. We also interviewed local Physical Education teacher Matt Slaba. He talked to us about how the school system is looking to improve physical activity levels for the kids in the community. The school just got done adding more playground equipment for community youth to take advantage of.

Wednesday was my last day. I woke up to a busy emergency room. We had multiple patients that had just arrived early that morning. After we had worked with those cases, I made the rounds to say goodbye and thank everyone at the hospital. It was bittersweet to say goodbye, because there were a lot of people that I wished I would have had more time to get to know in my time in Wagner.

My experience through the REHPS Program in Wagner has been amazing. I have gained a much better appreciation for the challenges that rural providers are facing. I have also learned how access to specific providers can be challenging for patients in rural communities. It has been great to see how Avera eCare and specialty outreach are being utilized to improve services in rural South Dakota. I cannot wait until the next chance I get to work with rural medicine in my education. It has truly helped me to grow as a student and a person.

To everyone that has worked with me throughout this program, thank you for helping me to learn more about rural healthcare and also myself. To the Wagner community, thank you for showing me true hospitality and welcoming me with open arms. To all those I met along the way, take care and God bless until we meet again.