Philip, South Dakota
Week 1

My first week in Philip, SD was great. It was filled with educational opportunities, not only in the application of medicine, but also for learning about the importance of quality healthcare in rural SD. I quickly learned that the Hans P. Peterson Memorial Hospital was started by one individual in the 1950’s. Since that time, the community has come together to provide the funds to keep the facility running. Everyone that I have encountered within the community has been very welcoming, kind, giving and encouraging. They have certainly made me feel as if I have always been a part of the Philip community.

Monday was a “get to know the hospital/clinic” day for me. Following a short orientation I was given a tour of the clinic, emergency department, hospital and long-term-care areas, all of which I will be a part of during my experience. My medical partner, Kim, will not be arriving for a few more weeks and will have introductions to other important aspects of the community after she arrives. I was introduced to three of the providers of the facility: Dr. Holman, Dr. Klopper and Terry Henri, PA-C. The provider I will be spending most of my time with will be Terry Henrie but at times will shadow the other provider as well. I was also introduced to the kitchen where lunch and supper is free for providers and students every day. During my time in Philip, a very kind-hearted woman, Phyllis Thorson, has taken me in at her bed and breakfast about 3 miles outside of town. She has also been so kind to make me breakfast every morning.

Tuesday was filled with seeing outpatients with Terry Henrie in the clinic. We saw patients of all ages with all types of problems. With living in rural SD, many times, patients have to drive an hour or two to see a provider. With this being said, there were a few times when more than one family member was seen while at the clinic. The providers and staff are more than happy to accommodate these situations. For supper, I checked out some of the local cuisine downtown and decided on a pizza eatery called Pizza Etc. Great food!

Wednesday morning I helped with preparing the noon meal at the community hall. One Wednesday of every month, members of the community gather to prepare and serve a meal to the community. It is one way that Philip brings individuals together for conversation, companionship and unity. We made and served salads, goulash, garlic toast and desserts. Approximately 75 individuals attended the luncheon which was an excellent turn out. In the afternoon I followed Janelle Gerberding, PA-C, a provider that comes to Philip once a week to provide care to the community. I was also on-call with her in the ED over-night. My preceptor, Terry, and his wife had Janelle and me to their home that evening for an amazing meal!

Thursday Terry and I went to the Kadoka for morning clinic. We saw several patients with the most memorable one being an older gentleman who had an abscess. Terry taught me how to lance, drain, and pack an abscess. We hurried back to Philip for afternoon clinic. That evening/night I was on-call with Dr. Klopper in the ED.

Friday quickly arrived. During the morning, we saw patients in the clinic. It was another day of seeing a variety of health concerns to include a dislocated finger, hand laceration, ear infections to sore throats. Terry was in clinic until noon. My afternoon was spent in the laboratory learning how to do blood draws. The techs also educated me with correlations between symptomology, diagnosis and which labs to order. Today I was also interviewed by the local paper for a short article that will be in next week’s issue.

Week 2
Monday: Terry was the only provider in the clinic/hospital today so we were responsible for the clinic, hospital, emergency department, and nursing home. This made for a very busy day. We admitted one patient from the nursing home to the hospital which was a new experience for me. I had the opportunity to write admission orders, perform an H & P and assist with a nasogastric tube placement on this patient.

Tuesday: Today we had our running shoes on. It was a busy day in the clinic but it was the ER that really kept us on our toes. If we weren’t tending to the rollover accident that brought in three patients, we were watching over patients that were sick from dehydration or septic infections. I also learned how to remove a fishhook that was lodged into the thumb of a fisherman. Today was a good demonstration of how the Philip Health Services receives and treats a variety of medical conditions. There never seems to be a dull moment!

Wednesday: First thing on my list of things to do this morning was to make rounds on the inpatients at the hospital. The remainder of the day consisted of tending to the emergency room and following the X-ray department technicians. Today I learned first-hand how, why and when to order CT scans and X-rays.

Thursday: More of the same today. Rounded on inpatients, worked in the clinic and tended to the ER. Interesting cases I saw today included a cowboy who was bucked from his horse and fractured his clavicle in two places; an acute CVA; and an emphysema bleb on a chest x-ray. There was an educational luncheon presented by a pharmaceutical representative over the lunch hour that provided us with information about preventing gout attacks with uloric.

Friday: My morning started off with a nice breakfast and good conversation with Phyllis, the Philip resident with whom I am staying with. She was excited to tell me about her upcoming plans for the day to include a trip to Rapid City to do some shopping with her daughters. She was also going to the state track meet to watch her grandson compete in the hurdles. My preceptor, Terry Henrie, was not seeing patients today so I followed Dr. Holman in the clinic. Besides the routine visits, I had the opportunity to evaluate and treat a patient with spider bites and help a little girl get her allergies under control.

Week 3
Monday: Today was my first day with my medical partner, Kim. Our day started off with a tour of Philip with our rotation coordinator, Jen. We were introduced to many of the businesses downtown, the pool, the high school, golf course and Lake Wagner just outside of town. We also had the opportunity to begin brain-storming ideas for our community project. Kim and I are leaning toward putting together a couple of community projects. We would like to provide a service to the youth of Philip by educating them about “sun safety” through the proper use of sunscreen. We would also like to provide a service to the adult community by educating individuals about the proper way to dispose of unused medications. We are interested in setting up a drug drop-off box either at the local pharmacy or at the hospital. My afternoon was spent in clinic with my preceptor evaluating, diagnosing, and treating patients. My evening was spent in the ER with Dave Webb PA-C.

Tuesday: Today we had a great luncheon with Kassy, our REHPS representative, at the local Steakhouse in Philip. She provided an educational session to the individuals of the community to give them the opportunity to learn about the REHPS program and the importance of bringing students and rural communities together. After her presentation, members of the community were given the opportunity to ask questions about the program. Kim and I also had a few questions brought our way about the program and about the Philip community. Having spent several weeks in Philip, I have found it to be a community of amazing people who are very proud of who they are and what they are working toward. Philip is truly a wonderful community and I am so gracious that they have taken me in and shown me how a small South Dakota town can make such a big difference in the lives of many.

Wednesday: Today Kim and I spent time with Philip’s local pharmacist, Milo Zeeb, and his staff at Zeeb’s Pharmacy. They successfully educated us about the ins and outs of the pharmacy. They even gave us the opportunity to assist in the preparation of filling some prescriptions that came into the pharmacy while we were there. Milo took us out for lunch and invited his daughter, Philip’s community health nurse, to join us. We spent the afternoon researching and planning our community projects. We sent emails to sunscreen and lip balm companies requesting free samples for our “sun safety” course that we will be presenting at the local pool. We were also able to locate a company that helps individuals set up a drug take-back program within their community. My evening and overnight was spent in the emergency department with Dr. Klopper.

Thursday: Today we focused on shadowing the laboratory and ultrasound departments. The lab technicians taught me how to process a CBC and a BMP and the importance of repeating abnormal findings for confirmation of results. Philip Health Services has a mobile ultrasound unit from Rapid City come to the clinic weekly to perform diagnostic testing. I spent the rest of my afternoon with Terry (PA-C) in the clinic. I spent my evening admitting a patient to the hospital and seeing patients in the ER with Dr. Klopper.

Friday: Today we had the chance to visit Philip’s assisted living facility, Silverleaf. We received a tour of the facility along with a few of the apartments in which the residents live. Since we were visiting over the lunch hour we took advantage of the opportunity to have lunch with the residents. We gathered together in the dining room and enjoyed great food and conversation. Kim and I also had time today to continue working on our community project. We are still planning on doing two community projects with a few additions to the drug-take-back program. We are also going to do blood pressure checks and blood glucose screenings along with the take back program. This evening we attended the musical “Honky Tonk Angels” that was performed by members of the community. The performance was fantastic to say the least! Philip is a very talented community!

Saturday: Today I worked in the clinic and the Emergency Department. The Philip Clinic is open every Saturday from 9 am until noon so this is where I spent most of my morning. During the afternoon and into the early evening hours, I spent time in the ER. With the kind help of the ER nurses, I had the opportunity to start my first IV today.

Sunday: Today I had a little break from the ER and the clinic and took the opportunity to catch-up on my studies. During the afternoon, Terry and Jennifer Henrie hosted a “REHPS celebration” in honor of us and the program. It was a nice opportunity to get to know some of the members of the community and to tell them about our goals and our focus while we are in Philip.

Week 4
Monday: My morning started off in the emergency room assessing and evaluating a patient with CHF. I also had the opportunity to spend some time with the laboratory technicians. They taught me about proper diagnosis coding, government regulations of their lab and a little bit about the different equipment they use for blood testing. The afternoon was spent compiling information together for our community projects.

Tuesday: Today we spent some time with Philip’s home health nurses; destination, Kadoka, SD. I quickly found out how great this service is. The nurses made sure that medications were being taken properly and they also did a medical assessment on each patient. All of the information was documented for future visits and appointments. It was very obvious how far a little TLC can really go.

Wednesday: This morning Kim and I were on a live radio broadcast. AM 1060 KGFX is a radio station out of Pierre that came to Philip to talk with members of the community about upcoming events. Kim and I talked about the REHPS program and about the projects we will be doing within the Philip community. We also had the opportunity to spend some time at the community health department. Heidi, the community health nurse, informed us of all the programs they have available for the members of the community.

Thursday: Today was a short and uneventful day. I spent the morning seeing patients in the clinic with Terry.

Friday: Today we spent the morning at the Kadoka clinic, a Philip satellite facility. My afternoon consisted of seeing outpatients at the Philip clinic. During my evening and over-night hours I was on-call in the emergency department. Tonight, Philip hosted a bronco riding competition; therefore I wasn’t surprised to see a few cowboys in the ER during my shift. Saturday and Sunday: This weekend there was a big celebration in Philip called the “Pioneer Days”. In the morning I ran in their annual 5K race. The race started and ended at park with the majority of the course winding the gravel roads just outside of town. It was a beautiful morning for a run and there was a great turn-out! I spent the rest of my weekend in the Emergency Room evaluating and treating patients with Dr. Holman.