A Native Place
An annual service trip for Geisel School of Medicine students in MD, MPH, and MS degree programs explores the state of Native American health across the Minnesota landscape.
Pediatrician Cassandra Rendon, DC’09, MD’18, credits her current job at Sanford Bemidji Children’s Clinic in northern Minnesota to an annual spring break trip she went on as a first-year Geisel medical student.
Nearly every year since 2010, Shawn O’Leary, director of Geisel’s Office for Diversity, Inclusion, and Community Engagement (DICE) has spent a week in March traveling around Minnesota with a cohort of students from the Geisel School of Medicine, including several from the Dartmouth MPH and MS programs. On Mr. O’Leary’s Indian Health Service Trip, students meet more than 50 tribal leaders and Native American health practitioners for a personal introduction to the array of healthcare and social issues Native American people face.
As a student trip leader in 2014, Dr. Rendon elicited guidance about trip priorities from Mr. O’Leary’s contacts in Minnesota and coordinated visit logistics, including mini service projects like serving meals at community centers and presenting workshops on substance use for school children. Throughout the remainder of her medical school career, Dr. Rendon completed two clerkships with the Indian Health Service, headed the national executive board for the Association of Native American Medical Students, and studied public health in the Dartmouth MPH program. Yet it was her time shadowing healthcare providers on the Red Lake Reservation as part of the Indian Health Service Trip that made her application stand out. “The person interviewing me said, ‘When I looked at your resume and saw you’ve already worked with the people who live in Red Lake, I knew we had to get you to work with us.’”
This year, Geisel medical students Rich Rosato, MD ’26, and Grace Palmer, MD ’26, served as trip leaders. “I’ve always felt like in medical school you have responsibilities to address healthcare inequities in your area,” says Mr. Rosato, who grew up in Concord, NH, and worked on local farms throughout high school.
Mr. O’Leary launched the program in 2009, at the behest of a Rural Health Scholar who proposed a spring break trip to work with native communities in the southwestern United States. Mr. O’Leary, whose family traces their roots to Nett Lake and the Bois Forte reservation, offered to tap his personal connections in Minnesota, instead, and spent a year laying groundwork for the first trip.
“There is a wealth of data that supports if you take a medical student early on in their medical education and have them engage with underserved, under-resourced communities, they will develop an interest in working with our most vulnerable communities in America and beyond,” says Mr. O’Leary. “Whatever community they engage with early on, they’re more likely to engage later in their careers—the ultimate goal is getting people to go back and serve.”
Board-certified pediatrician Angie Erdrich, DC’87, MD’94, a member of the Turtle Mountain Chippewa (Ojibwe) and a distant cousin to Dr. Rendon, hosts a welcome dinner in her home for everyone on the trip as a way of honoring her Dartmouth legacy and the vibrant local American Indian culture and practices. “The holistic health experience is unique here,” says Dr. Erdrich, who practices with the Indian Health Board of Minneapolis and got involved with the trip at Mr. O’Leary’s invitation in 2012. "I want the students to experience a view of a U.S. city where native people are re-establishing their sense of place. This is a native place, with native stamps all over it.”
After their welcome dinner, the 20 Dartmouth students who traveled to Minnesota this year split into four teams sorted by the reservation communities in which they would spend the bulk of their visit:
- Urban Minneapolis
- Leech Lake
- Bois Forte
- White Earth
Doan Pham, a Dartmouth MPH student, grew up in Ho Chi Minh City, Vietnam. She traveled to Bois Forte, almost four hours due north of Minneapolis. The small, rural community is remote; even the nearest grocery store is a 30-minute drive. “A lot of the disparities happen because of issues of transportation that limit people’s access to services," says Ms. Pham, who is also a global director for the Geisel chapter of the International Medical Student Association. “Instead of going regularly for prevention, they go when they have symptoms, so they need medications. Sometimes it creates a cycle of disease, instead of a cycle of prevention.” Yet Ms. Pham also noted the care community members extend to one another. At the local clinic, healthcare providers relied on written notes during their visits with an elder who had trouble hearing and a neighbor drove her to appointments.
“I was touched by how the community members take care of one another when they have an opportunity,” says Ms. Pham.
Dr. Rendon and her husband hosted the Leech Lake team. The couple served buffalo and wild-rice stew, let the students dandle their infant and toddler, and made up a bed for each of their visitors. Dr. Rendon kept things light, urging the sleep-deprived students—who had departed Hanover only hours after completing a grueling series of finals—to hold steady.
“Medical school was the hardest time in my life,” she says. “I talk to them about how getting through medical school means becoming a doctor who can make a difference.”
Dr. Rendon— a member of the Turtle Mountain Band of Chippewa and the Ogala Lakota Nation—is the only native physician in her department, which serves the people of Bemidji and of Red Lake, as well as the Leech Lake and White Earth reservations. During the students’ visit to Sanford Health she gave a talk about the values and insights that inform her work. Knowing the pervasive challenges of unreliable transportation for her rural patients, she has forgiving policies on no-show and late patients. And when it comes to native patients, she keeps intergenerational impacts in her sights.
“I’m trying to keep native families together,” she says, “in a place where, historically, it’s very well known that natives get removed from their homes and placed with people who don’t share their culture and values.”
To help students make the most of their week in Minnesota, Mr. O’Leary and the tribal hosts share a wealth of background reading about topics the students will encounter during their visit. Students also read and discuss The Scalpel and the Silver Bear, a memoir by Diné surgeon Lori Alvord, DC’79, who was associate dean for student affairs, as well as an assistant professor of surgery and psychiatry at Dartmouth from 1997 to 2009.
Mr. O’Leary also shares stories from his own heritage, including his grandmother’s accounts of her experience at an Indian Boarding School and the intergenerational effect of the U.S. government’s attempt to stamp out Native American culture and language on himself and his father.
Over the winter, the students traveled with Mr. O’Leary to Vermont, where they harvested red willow to craft medicine bags that combine shavings of the plant’s inner bark and native tobacco. In Minnesota, the students gave the bags, known as kinnikinnick, to each of their hosts. "Everyone we gifted them to was blown away that a group of college kids from New Hampshire would know to offer kinnikinnick as a sign of thanks,” says Mr. Rosato.
“The students are visiting with guides, people who are there to help them get a full perspective,” says Dr. Erdrich. “It’s not tourism; it’s like how a family member would show you something—they’re taken under someone’s wing.”
Even so, Mr. Rosato and Ms. Palmer worried that the short time students spend in Minnesota could easily veer into “voluntourism.” “An Ivy League school like Dartmouth could be a huge offender,” says Mr. Rosato. Mr. O’Leary has long urged trip participants to look for opportunities to return to Minnesota over the summer for more extended service-learning projects. One year, participants helped the Little Earth community in Minneapolis— the only indigenous preference project-based Section 8 rental assistance community in the United States—conduct a health needs assessment. Students knocked on hundreds of doors to listen and document feedback from residents about their experiences as urban-dwelling, low-income, indigenous people. A Dartmouth MPH and MS student who visited Leech Lake in 2022 is now working with their hosts to develop a health needs assessment for that community.
This summer, Mr. Rosato will attend the Bois Forte pow-wow with a delegation from the Dermatology Department to do sun protection outreach, part of an ongoing effort by tribal leadership and Dartmouth Health to establish a telehealth and consulting relationship for a community where specialists are in short supply. Ms. Pham plans to pursue a degree in optometry; having seen first-hand the need for specialty services in Bois Forte, she’s weighing the possibility of a career in rural healthcare. In Bemidji, Dr. Rendon has begun the process to become a clinical preceptor for third-year students doing their pediatric clerkships.
“I can’t believe how generous the tribes and our partners are,” says O’Leary. “No other students in the country get an opportunity like this.”
-Written by Sharon Tregaskis
-Edited by Suzanne Shrekgast
-Photographs provided by Richard Rosato and Doan Pham