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Like many physicians trained in public health, Drs. Emmett Chase, MPH ’90, and Eva Marie Smith, MPH ’90, have devoted much of their careers to addressing issues of access to care in their community. But for the couple, who have spent the last 16 years tending to the health needs of the Hoopa Valley Reservation in rural Northern California, the issues are unlike those faced by most of their former classmates.
In 1997 Chase, a member of the Hoopa Valley Tribe, accepted an invitation by his tribal chairman to serve as founding director and CEO of the new K’ima:w Medical Center. Smith, also a family physician, became medical director shortly after the clinic opened and continues to serve in that role; after nine years as CEO, Chase is now a staff physician.
Located in a remote wooded community where life revolves around the Trinity and Klamath rivers, K’ima:w is the only clinic within 60 miles in an area with winding roads that are difficult to navigate in the winter. “This population had limited access for a long time,” says Chase. In addition to periodically bringing in specialists on site, K’ima:w has established an active telemedicine program that enables patients to connect with university specialists. Beyond that, Chase and Smith log many miles making house calls, and regularly receive home visits and phone calls from patients.
Given the emphasis on extended family in Native American culture, many patients with chronic conditions who might otherwise prefer to live closer to a university hospital choose to remain at home with their family, able to participate in tribal ceremonies and enjoy the area’s impressive beauty. “It’s our job to help them do that, and provide them with what they need,” says Smith, who was recently honored with the California Medical Association’s 2013 Frederick K.M. Plessner Memorial Award, given to the member who best exemplifies the practice and ethics of a rural practitioner.
Smith, a member of the Shinnecock Tribe of New York, met Chase at an Association of American Indian Physicians meeting in 1984; they were married in 1988 and had their first child while both were students at the Fielding School. By that time, both were leaders in the Indian Health Service (IHS). Chase was director of the IHS’s HIV/AIDS program for seven years; Smith led efforts on the prevention and treatment of substance abuse – an issue of particular concern in Native American populations.
Shortly after the couple moved to Hoopa Valley, they faced the challenge of their careers. The Megram wildfire in the summer of 1999 burned 125,000 acres and produced dangerously high levels of smoke in the area for a month. In addition to overseeing the clinical care of the community, Chase and Smith found themselves addressing the acute needs of patients with heart and respiratory conditions. Hoopa’s population doubled from the fire fighters working in the community; along with supporting them, the couple helped to evacuate 200 of the most vulnerable community members to the California coast.
“We were determined that Hoopa wasn’t going to be one of those communities studied in the books years later for what went wrong,” says Smith. Thanks to the couple’s leadership, the community got through the period with no mortality. Reflecting on the ordeal, Smith concludes: “Every ounce of our UCLA public health training paid off.”
K’ima:w Medical Center