A View from the Cockpit: “Dr. Yeakel, can you meet the ambulance at Wounded Knee?”

October 2022

---

“Dr. Yeakel, can you meet the ambulance at Wounded Knee?”
Essie WhiteFace, Ambulance Services Director, Pine Ridge Indian Reservation, South Dakota

That call came to our Indian Health Service (IHS) Hospital in Pine Ridge on a winter night in 1982. There had been a trauma in the town of Wanblee, 90 miles northeast within the reservation. The ambulance was heading to our hospital, and the patient was not doing well.

I grabbed some MAST trousers (Military-Anti-Shock Trousers) [1] and within minutes was in a tribal police car heading for the rendezvous. The 17-mile drive to Wounded Knee, through sparsely populated mixed grass prairie, left us waiting under a night sky filled with a brilliant Milky Way. Red emergency flashers announced the ambulance approach from the northeast, up on the mesa, miles before it reached us. The ambulance, a humbly equipped GMC Suburban, met us on the very land where in 1890 the Wounded Knee massacre claimed many Lakota lives. Once in the ambulance, I faced a patient in hemorrhagic shock, in need of surgery and critical care that our hospital was ill prepared to offer.

Reservation life is hard for the Oglala Sioux with 50 percent of the population below the federal poverty level. Health conditions include depression, alcoholism, drug abuse, malnutrition, and diabetes. Life expectancy is 47 years for males and 52 years for females, the shortest life expectancy in the Western Hemisphere. Infant mortality is five times and adolescent suicide rates are four times the United States national averages. The IHS runs the on-reservation hospital and health system. From 1981 – 1983, and certainly that winter night, as one of a few general medical officers on the reservation, I knew that resources and personnel were insufficient to address stubborn and profound health disparities and inequalities.

The past four decades of efforts have not corrected the challenges of health care inequity on reservations nor throughout the United States, including South Carolina [2]. Myriad complex reasons account for those inequities. The pandemic both unmasked and amplified some of them.

While all South Carolinians were at risk from the virus, the rates of death, illness, and other impacts did not touch us equally. Our citizens and patients of varying race, ethnicity, income, education, location, and housing faced differing access to reliable health care and health information.

Our state’s physicians have always cared for patients with competence and commitment, especially these past years. It is important to highlight the opportunities provided by the SCMA for physician service on a broader scale, in over 20 state boards and agencies. These organizations are involved in addressing health inequities on a scale beyond the individual patient. To name a few and just some of those involved:

• The South Carolina Institute of Medicine and Public Health (IMPH)
  • IMPH Taskforce members (SCMA physicians and leadership): Helmut Albrecht, MD; Shawn Stinson, MD, FACP (SVP Blue Cross Blue Shield SC); Richele Taylor, Esq, (SCMA CEO); Rick Foster, MD; Patrick Cawley, MD; Linda Bell, MD; and L. Brannon Traxler, MD, MPH (SC DHEC). Other physicians include Robin LaCroix, MD; Danielle Scheurer, MD; Christine Carr, MD; and Ken Rogers, MD.
    
    
• Alliance for a Healthier South Carolina
  • Shawn Stinson MD, FACP (Alliance Chair); L. Brannon Traxler, MD, MPH; Bruce Snyder, MD (Past Alliance Chair); and Richele Taylor, Esq.
    
    
• Diabetes Initiative of South Carolina Board
  • Diedre Tyson, MD
    
    
• Emergency Medical Services Advisory Council
  • “Mac” Nowell, MD
    
    
• Trauma Advisory Council
  • Jeremy Reeves, MD
    
    
• MUSC Rural Physician Program
  • Jeffrey Cashman, DO
    
    
• The Physicians Foundation
  • March Seabrook, MD
    
    
• South Carolina Mental Health Commission (Department of Mental Health)
  • Crystal Maxwell, MD
    
    
• DHEC Board
  • Robert R. Morgan Jr., MD, MBA
    
    
• DHEC SC Vaccine Advisory Committee
  • Jefferey Cashman, DO; Shawn Stinson, MD, FACP; and Linda Bell, MD
    
    
• DHEC SHAPE Taskforce
  • Edward Simmer, MD and Richele Taylor, Esq.
    
    
• Division and Advisory Council on Aging State Loan Repayment Program
  • Timothy Kowalski, DO, FACN
    
    
• Birth Defects Advisory Council
  • Steven A. Skinner, MD
    
    

In addition to the above statewide bodies, physicians are working in other ways with multiple partners, including the SCMA, to address broader health inequities.

• No One Left Alone (NOLA) aims to address cancer health disparities and improve access to care.
  • SCMA physicians Kashyap Patel, MD; Niyati A. Nathwani, MD; Emily Touloukian, MD; Sashi Naidu, MD; Viral Rabara, MD; Asutosh Gor, MD; and Holly Pisarik, Esq. (SCMA Senior VP of Advocacy and Policy Counsel).
    
    

Health care systems need to be accessible to all and nimble in care delivery. Behavioral health services must be enhanced and remodeled to provide better access to care. The increased incidence of mental health illnesses during pandemic stressors and isolation put a further strain on limited resources. Our profession of medicine and the SCMA are integral partners statewide in addressing these needed changes.

The reservation had no SCMA equivalent as a resource for the few physicians living and working there. In contrast, South Carolina physicians have had the SCMA serving and supporting them since 1848! The power of the SCMA and organized medicine to address health inequities and improve the health of South Carolinians lies within the collective actions and voices of you, our physician members. We are “better together” and as always, I welcome hearing your voice at scmayeakel@gmail.com.

References:

[1] The Rise and Fall of MAST Trousers, StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. https://thetraumapro.com/2022/10/11/the-rise-and-fall-of-mast-trousers/

[2] South Carolina Health Professions Data Book, December 2021, South Carolina Office for Healthcare Workforce, http://www.scshec.net/scohw