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**ACOG works to improve health among Native American women**

***Fellows in Service program offers challenges and rewards***

"I decided to participate to pay back society, because I felt medicine
had been good to me," says John S. Mutterperl, MD, a retired physician
from Massachusetts, speaking of his work with the Navajo in New Mexico.
"I found that it was one of the most enriching experiences of my life
and has helped to make my retirement worthwhile."

Dr. Mutterperl is one of numerous ACOG Fellows who have participated in
ACOG's Fellows Serving Native American Women program, begun in the
mid-1970s, soon after the creation of the ACOG Committee on American
Indian Affairs. The committee helps the US Indian Health Service recruit
ob-gyns for full-time positions at IHS hospitals. The Fellows in Service
program places ob-gyns at IHS hospitals for brief periods to provide
coverage for vacation, maternity leave, continuing education or when
staff positions are temporarily unfilled.

Before his first ACOG assignment, Dr. Mutterperl asked to complete an
obstetrics refresher course at his local medical school; he wanted to
bring his sharpest skills to this demanding professional experience. He
has completed eight assignments as a volunteer in Gallup, NM, and
northern Arizona's Fort. Defiance. "The work is always the high point of
my year," he notes. "To me this is ideal medicine. It's hard work and
very complicated obstetrics, but also an incredibly enriching
experience."

Phoenix ob-gyn Diana M. Herman, MD, who worked with the Navajo at the
Tuba City Medical Center, concurs. "The idealism of the IHS physicians,
who sometimes faced overwhelming need, was refreshing. They welcomed the
relief provided by ACOG Fellows. Many of them were recent graduates of
residency programs and they enjoyed the 'pearls' that seasoned
physicians were able to provide. The experience offered a personal time
of reflection, too, with hikes in the countryside away from the usual
busy city life."

**Practice, patient differences challenging**

Dr. Mutterperl and Dr. Herman both noted cultural and geographic
conditions that made practice challenging. "The Navajo don't like to
talk about the future and won't even name their babies in utero," says
Dr. Mutterperl. "This makes the provision of prenatal care and
preventive services difficult. I also found myself dealing with a great
number of high-risk obstetric cases. This is because the smaller, more
rural hospitals in Crownpoint and Zuni, NM, are staffed by family
physicians who must send complicated ob-gyn cases to Gallup Indian
Medical Center."

"It's a very high-risk and needy population," agrees Dr. Herman. "I saw
a number of abnormal Paps, for example. Sometimes, however,
long-standing problems can be easily rectified. I fitted a 72-year-old
grandmother with a pessary for severe uterine prolapse. This was a
condition that had plagued her for ten years, and she was extremely
grateful. I also became an instant hit when I went to a local Wal-Mart
and bought heating pads for the drawers where the speculums were
stored."

**Alaska Native Medical Center draws patients for 1,000 miles**

Deborah C. Eisenberg, MD, of New York, and John E. Tillis, MD, of
Illinois, both completed assignments in Anchorage at the Alaska Native
Medical Center. The hospital at Anchorage, with state-of-the-art
computer and medical technology, is the referral center for the entire
state. "Throughout the day, the on-call physician is fielding calls from
health aides, nurse practitioners, and other doctors with management
questions and transfers," says Dr. Eisenberg

"Part of my orientation was to be shown on a state map where the calls
would come from," notes Dr. Tillis. "Nome, Barrow, or Kotzebue are all
about 800 miles away, and there are some places in the Aleutian Islands
more than 1,000 miles away. There is an extensive use of air transport
from all of these areas."

Dr. Eisenberg explains, "Pregnant women in the villages are transferred
to regional 'towns' to await delivery, and cases that arouse the
smallest degree of concern are transferred to Anchorage. The system is
well-managed and all this consultation and air transport works."

**Physicians benefit as much as patients**

Fellows who participate in the program express overwhelming enthusiasm
for the experience, and many request additional assignments.

Part of what makes the assignments so rewarding is working with Native
American women. "I can't describe to you how enlightening it was to be
among these women," says Susan M. Richman, MD, of New Haven, CT. "They
are kind, considerate, less complaining and happier than women in my
Yale hospital practice in New Haven. Where else do patients step aside
to let an elderly woman be seen first? Where else would you find teenage
boys bringing their grandmothers in for Pap smears? I intend to continue
with this service every year until I die."

Peace. Contentment. An escape from the materialism, stress, and rush of
city life. "I felt I spent the summer 'detoxing' from residency and the
fast pace of the Northeast," comments Dr. Eisenberg. "My eight weeks in
Alaska among Native American women and their beautiful home has taught
me to appreciate life and time spent with the people I care about. I
return to the hustle and bustle of New York a changed woman, longing for
the glaciers and the quiet."

**ACOG program has made a difference**

The Fellows in Service program described above is one of three areas of
ACOG's collaboration with the IHS. The College also surveys Indian
health facilities and provides postgraduate courses for physicians
working there.

ACOG's work among American Indian women began in 1970 with the creation
of ACOG's Committee on American Indian Affairs. At that time the
maternal mortality rate of American Indian and Alaskan Native women was
nearly 2.5 times that of Caucasian women, and only seven ob-gyns in the
entire US were providing health care to this population. Since then,
maternal mortality has dropped 75%, and hundreds of Indian Health
Service and tribal nonspecialist physicians and nurses have been trained
by ACOG.

For more information about the Fellows in Service program, contact
Yvonne Malloy at 800-673-8444 or 202 638 5577, or e-mail Yvonne at:
ymalloy@acog.org