Or, how the UND Indians Into Medicine program survived—and thrived—in the new century.
The following is the second of two North Dakota Medicine stories focusing on the history of UND's Indians Into Medicine Program. Whereas the first story focused on the program's early history, this piece covers INMED in the 21st century.
Gene DeLorme paused, choosing his words carefully.
“We went from nine employees to four,” DeLorme emphasized, still wincing at the thought. “When you look at that fact, and take inflation into account and purchasing power, that’s devastating. But we carried on with the same program and burnt ourselves out trying to do same workload as nine people.”
DeLorme, an attorney by training who was Indians Into Medicine (INMED) Director at UND’s School of Medicine & Health Sciences (SMHS) from 1994 to 2017, is referring to the $600,000 loss the program suffered in 2006 when Congress cut the Health Care Opportunities Program, one of two federal programs that had been keeping the program afloat.
In an instant, INMED’s operating budget was cut almost in half.
Making the cut deeper was the fact that DeLorme and his team had just helped INMED reach a level of stability following other budget troubles and a federal audit in the mid-1990s—which he was brought in to manage. Now he was being put in the position of both reducing the scope of services the program provided American Indian students interested in health careers and cutting staff positions.
But while such blows could have meant the end of INMED at UND, DeLorme and his team soldiered on, wounded, but dedicated to accomplishing its mission.
And the University of North Dakota is better for it.
Home away from home
The workload DeLorme references cannot be underestimated. Although INMED began in 1973 as the nation’s first program specifically to assist American Indian and Alaska Native (AIAN) medical students, by DeLorme’s time the program had expanded tremendously.
In the 1990s, INMED not only was providing support services to medical students but managing a Medical College Admissions Test (MCAT) prep course for pre-medical undergraduate students, a Summer Institute (SI) that brought dozens of middle and high school students to UND’s campus for science education each summer, and even was bringing science education to reservation schools in North Dakota.
And it began offering on-campus support to American Indian students in affiliate health programs from nutrition & dietetics, medical laboratory science, and nursing to social work and, yes, engineering—on the assumption that reservation hospitals, like any health facility, needed social workers and engineers to function.
Kathleen Fredericks remembers those days well.
“We had study hall, prepared meals on occasion, and had more events then,” explained Fredericks, referencing the art show, student organization, and annual powwow that INMED at one time sponsored. “This space was truly a home away from home for these students. It was very supportive.”
A 17-year veteran of the program, Fredericks today oversees INMED’s “Med-Prep” summer programs and advises medical and pre-medical INMED students. She too was there when the program was expanding—and then contracting.
And as Fredericks’s colleagues suggest, even if INMED no longer makes fry bread for its students, its value-add hinges on its status as a second home, which increases retention and graduation rates for American Indian students, some of whom had never set foot off the reservation before their Summer Institute session or freshman year at UND.
“There’s a sense of community about these programs and what students experience here,” smiled Dr. Joycelyn Dorscher, the SMHS associate dean of Student Affairs & Admissions who served as INMED’s interim director following DeLorme’s retirement in 2017. “That’s exactly what these kids need. It’s important for students to come here and be exposed to the college environment, and get excited about it. They make connections with other people—those connections stay. INMED is all about relationships, which is how you build trust in tribal communities.”
Or, as the program’s assistant director Dr. Siobhan Wescott puts it, since not a lot of American Indians have a family member in medicine to guide them through the process—yet— INMED itself functions as that guide.
“Having gone through med school myself, it seems that the number of med students in general who have a parent or close family member in medicine is very high,” said Wescott, who also serves as chair of the Minority Health Section for the American Medical Association. “You need someone who is close to you to help you through this incredibly long, complicated process with all its nuances. INMED has been a steady presence in a rough sea for native students getting through medical school. It’s a great model and we have a lot to be proud of.”
This, then, is the role INMED has tended to emphasize in a 21st century economic environment known for its austerity: the mentor-guide, the provider of a version of what novelist and poet Louise Erdrich called “love medicine.”
All of which is to say, although it may not cook meals for students much anymore, INMED has survived numerous challenges and emerged—almost against the odds—as committed to producing AIAN health providers as it was in 1973.
And there is at least hope that it might begin to expand its scope again: both Wescott and Assistant Professor Nicole Redvers, ND, have been brought on board to help current INMED Director Dr. Donald Warne (right), who also serves as the School’s director of the Master of Public Health (MPH) program and its associate dean for Diversity, Equity & Inclusion, move the program forward.
“We should be thinking further upstream,” Warne recently told a group of American Indian health professionals at the Strengthening Academic & Tribal Partnerships in the Great Plains conference, hosted by the SMHS. “We should be thinking K-12, not just middle-school, and maybe even pre-K for INMED. And looking downstream, we should be thinking about INMED residency programs and other leadership development programs.”
This vision of a 360-degree INMED—kindergarten STEM education through post-graduate residency training—is the type of bold and comprehensive thinking Warne was brought in to help the program initiate in 2018.
“We are in process of developing an INMED pre-med program at the bachelor level,” continued Warne, referencing also his vision for dual MD/PhD and JD/MPH degrees for American Indian students interested in health policy, research, and law. “These are all moving forward. And nationally there are many preventive medicine residencies, but none that focus on rural and tribal populations. That’s something we really need—a focus on preventing disease.”
All of that will take time to realize, of course. But after a handful of tumultuous years around the turn of the century, INMED is perhaps in the best position to expand its vision than it has been since its founding nearly 50 years ago—and see hundreds more AIAN students bring their UND degrees back home to communities across North Dakota and the nation.
“Those were always the most significant moments for me— when I got to sit on the stage of Chester Fritz Auditorium and watch that seventh grader cross that stage and get their MD degree,” concluded DeLorme. “That’s when they first came to us, seventh grade. And they went through all five years of SI and did undergraduate and medical school at UND. So that was a pretty special day. It doesn’t get much better than that.”