By Grace McOmber
School of Medicine

At the Virginia Commonwealth University School of Medicine, training to be a doctor includes more than long hours studying and clinical rotations. For graduating student Austin Barnhardt, his medical school journey also entailed traveling to the desert of New Mexico to serve in one of the country’s most rural communities. 

Last July, Barnhardt spent a month in a small trailer in Shiprock, New Mexico, a subdivision of the Navajo Nation. With only a window unit air-conditioner to combat the desert heat, Barnhardt lived and worked alongside the Navajo community, learning the intricacies of providing primary care within marginalized communities. 

Now preparing to graduate from the M.D. program at VCU, the North Dakota native is ready to head back to the mountain west. He matched into a family medicine residency program and will soon bring his skills and passion for rural care to the small town and surrounding areas of Billings, Montana. 

“There are so many desirable things to find in these ‘undesirable areas,’” Barnhardt said. “In rural medicine, you get the privilege of becoming one with the community and really getting to know the patients you serve.”  

Immersion as education 

Barnhardt’s trip to the Navajo Nation was an immersion experience as part of the Internation/Inner City/ Rural Preceptorship (I2CRP), a four-year longitudinal course for students committed to working in primary care with medically underserved populations. 

The goal of the program, according to Mark Ryan, M.D., medical director of I2CRP, is to teach students to identify the specific needs, resources and gaps of the patients and communities they are hoping to serve as physicians. I2CRP students complete clinical rotations in community-based settings during their third year in medical school and a month-long community immersion rotation of their choice during their fourth year. The community they choose is meant to represent the one they are hoping to serve in the future, and through immersion, Ryan said, students can get a deeper understanding for what working in a similar community will be like. 

“They’re doing what they would do as practitioners. They’re not coming home to study or take exams,” Ryan said. “It allows them to engage more deeply with patients and better understand the role of a health care provider in this setting, as opposed to focusing on coursework requirements."

Growing up in Bismarck, North Dakota, Barnhardt has seen the struggles of accessing health care in rural settings. One of his first jobs was in Elgin, North Dakota, where he was a nursing assistant at Jacobson Memorial Health Care Center, a critical access hospital that serves the town’s 543 residents.  

“In rural areas, the family medicine doctors really do it all,” Barnhardt said. “From the clinic to inpatient to the emergency room, they’re often the only ones in the community that can provide that care on the spot.” 

Barnhardt brought his lived experience and medical education to the family medicine department of the Northern Navajo Medical Center, an Indian Health Service institution providing acute, chronic and preventive care to Navajo patients — including some who had to drive hours to receive it. 

His own living conditions on the reservation were a constant reminder of the systemic barriers the community faces when it comes to health care. The roads he traveled each morning were unpaved and rolling blackouts were commonplace — 32% of Navajo Nation households have no electricity at all. The sole nearby grocery store rarely stocked fresh produce, and Barnhardt said a bulk of his meals came from McDonald’s, one of many fast-food options that lined the streets.

“How can I tell a patient to eat healthily, when I’m not even eating healthily? How can I tell them to exercise when they don’t have access to a gym and it’s 90-plus degrees Fahrenheit outside?” Barnhardt said. “That’s what immersion is all about –– putting yourself in other people’s shoes to understand the barriers they face.” 

Building trust and communication was key to working in the Navajo Nation, Barnhardt said. This was especially true for another of his rotations at NNMC — Sih Hasin Street Medicine, a preventive care program for unhoused Navajo citizens. Working with this community often meant handing food and water out of the back of a van, as a practice of what NNMC staff call “reality-based medicine.” 

“It’s about starting from the ground up and meeting people where they are. Maybe all someone wants today is a burrito and water,” Barnhardt said. “But if or when a medical issue pops up, that trust is there and they feel more comfortable coming to us with that issue.” 

While challenging, Barnhardt said the immersion experience was immensely rewarding. He recounts meeting a Navajo elder who didn’t speak much English and working with a translator to address her health concerns. The next time they saw each other, the elder greeted Barnhardt with her name and clans, a Navajo custom. 

“That was a really impactful moment for me,” Barnhardt said. “In one quick visit, you can build a lot of trust and connection.” 

Moving back and looking forward 

Barnhardt said he is excited to return to the mountain west, live closer to family and expand on his work with Native American populations in Montana, home to 12 federally recognized tribes. The Montana Family Medicine Residency Program operates out of satellite clinics across Montana and offers many tracks, including wilderness medicine, which Barnhardt said he is particularly interested in. 

Barnhardt completed medical school on a Veterans Affairs Health Professions Scholarship, a program that covers the cost of medical school in exchange for service at a Veterans Affairs institution following residency. Coincidentally, Native Americans have the largest number of service members in proportion to their population of any demographic, and Barnhardt hopes to serve in an IHS-funded institution at some time in his career. 

“There’s a lot of overlap there, which I’m very excited about,” Barnhardt said. “It’s two very underserved populations, and I think it’s a privilege to be able to work with both.”

This story was originally published on the School of Medicine website.