Choosing health care as a profession

SAULT STE. MARIE, Mich. – Attention medical professionals who will be graduating in a year or two with large student loans to repay: the IHS Office of Public Health Support would like to hear from you.

And graduating high school seniors considering pursuing a health professions degree, take note – the IHS offers a competitive scholarship program that you may be qualified for.

Mary Beth Skupien, deputy director for the Office of Public Health Support at IHS, began her 26-year career with IHS doing rotations as a nursing student at an IHS community clinic in Kincheloe. During her work at the clinic, an IHS employee told her about a scholarship opportunity and that if she qualified it would pay for her master’s degree.

“I applied with a deadline of two weeks and was accepted for my master’s degree at the University of Michigan,” she said. “I owed IHS two years of service and had to go wherever the need was when I was done with my degree.

“My first duty station was in Kingman, Ariz., with the Havasupai and Haulapai tribes. I spent one week a month at the base of the Grand Canyon as a nurse practitioner and community health nurse providing care for about 400 Havasupai Indians. The other three weeks I spent on top with the 3,200-member Hualapai Tribe. I worked there for about two years and transferred to Phoenix, where I was the public health nursing director and health care administrator.”

After working for five years in the Phoenix area office as the planning, evaluation and information resource director, she became the CEO/service unit director of the Southern Colorado Ute Service Unit in the Albuquerque, N.M., area. From there she transferred to the IHS headquarters office in Rockville, Md., overseeing clinical programs in the IHS as the deputy director.

In a diabetic’s words Anger and denial were the reactions long-term care geriatrics nurse Roberta Schaedel had when she received news that she is a Type 2 diabetic who would be dependent on insulin for the rest of her life. She works for Bortz Health Care, a clinic in Petoskey, Mich. "I really went through a tough time being very angry and, having been overweight my whole life, it was like another slap in the face being a diabetic," she said. Schaedel travels 45 minutes one way to be treated for her diabetes at the Sault Tribe Lambert Center Health Clinic in St. Ignace, which is funded by IHS and tribal dollars. "I love my providers and the holistic care I receive there. To help patients manage their diabetes, they offer nutritionists, certified diabetes educators and medicine free of charge, which includes diabetic meters. I am confident the delivery system they have is the best in the United States," she said. "It is kind of like going home to go to the doctor." Mary Beth Skupien, Ph.D., deputy director for the Office of Public Health Support at the IHS, said, "IHS Division Director Dr. Kelly Acton and her staff at the Office of Clinical and Preventive Services Diabetes Program really deserve a lot of credit for the diabetes program which is out of the national office in Albuquerque. They have done wonders and touched many lives. "The diabetes program is on the cutting edge of health care for diabetes and has a state-of-the-art model of care curriculum and programs. Other countries such as Canada, New Zealand and Mexico are looking to IHS for the way we deliver care. IHS is partnering with other countries and universities because the diabetic care in Indian country is the best around." Having lived all over the world and seen firsthand different models of health care, Schaedel said IHS and the tribal clinics have a holistic approach with cradle-to-grave care that really stresses prevention. "They don’t just treat your disease; they look at the whole person and address every need. I was also offered counseling to help deal with my anger and denial. The nutritionist is very knowledgeable and works with you to build a program you are comfortable with that will work long term. "I know I am getting the best possible care, thanks to IHS, the tribe and the staff at the Lambert Health Center," she said. "I love my doctor, Dr. Pramstaller. She is the best doctor one could ever hope for."

“While I was there, I was blessed because there was one long-term training slot available and I was allowed to apply for it to obtain my Ph.D. I applied and was accepted into the Johns Hopkins University Ph.D. program in public health, management and policy. IHS granted me a two-year sabbatical and paid my salary, and after two years I returned to work.”

During her two-year sabbatical, she spent almost a year in San Carlos, Ariz., collecting data for her dissertation from a tribe she had worked with in the 1980s. “I looked at domestic violence against American Indian women and co-morbidities of depression, PTSD [post-traumatic stress disorder], alcoholism and cultural issues. When I returned, I was able to do my data analysis and defend my thesis in six months,” Skupien said. “The one thing that has really influenced my whole life is our Creator. He has been my pilot. I have been blessed throughout my career: IHS has been awesome.”

In 1999, while on a five-year detail, she came home to the Sault Ste. Marie Tribe of Chippewa Indians and spent five years as the health director of the tribe’s health program.

The Office of Public Health Support oversees 562 tribal programs including epidemiology; planning, evaluation and research; IHS scholarship program and loan repayment; physician recruitment; and program statistics. “The delivery system at IHS can be matched by none,” she said. “It is not just IHS; it is the tribes, urban health programs and Indian Health partners working together.

“The goal at IHS is for the tribes to manage their own health programs with funds from IHS. I am really proud to say that over half the programs are managed by tribes right now. Our mission is to raise the health status of American Indian and Alaska Native people to the highest possible level, and this is what we do daily in our jobs.”

There are currently about 584 students in the loan repayment program. “This program is very underfunded; we get about $24 million for that program, but there are as many people that we don’t fund because we don’t have the money.

“The scholarship program trains scholars like myself and after they are done with school they owe a payback to Indian country. It is a very competitive program. We had 1,200 applicants this year and were only able to fund 100 new scholarships. This program looks at GPA, leadership, references and the skills demonstrated in high school or college.

“The sad part is we only get about $14 million for that program and we probably have an additional need for $50 million for both the loan repayment and scholarship programs,” she said. “We have great advocates with the tribes, many of which have come forward to support these programs and see them as an investment in their future.”

In the last 25 years, IHS has trained more than 8,000 health care providers. “In our office, we have six people in key leadership positions who are all graduates of the scholarship program, from myself to middle managers. Our new chief medical officer is a scholarship graduate.

“We are here to serve. We call it the Indian Health Care System; it’s the best. We have an exciting future at IHS.”

For information on the scholarship or loan repayment programs, visit www.ihs.gov or e-mail Skupien at marybeth.

“I had a two-year service payback for my master’s degree and another two-year payback for my Ph.D., and here I am, 26 years later,” she said.