As a pediatrician in Fort Defiance, Ariz., Michael Bartholomew ('03) would sometimes ask his patients a common question: "What do you want to be when you grow up?"
Their uncommon response stunned the young doctor.
"I was shocked at the silence that the question evoked from these children, my patients," says Bartholomew.
Of the many deep disparities found within American Indian and Alaska Native communities—income, diabetes, heart disease, education—Bartholomew had stumbled upon one more: an inability to dream or to see a better future.
"One child said, 'Indians don't become doctors,' after I told him I was Native American," Bartholomew recalls. "From that point on, I tried to expand what they felt was possible, and help them see that their future is an open book."
Bartholomew's own dreams to make a difference with his life took shape early on, growing up with two parents who dedicated their lives to service.
"My parents both worked for the Indian Health Service [IHS] and they described the health disparities that existed among American Indian and Alaska Native people," says Bartholomew, now the director of the IHS Division of Epidemiology and Disease Prevention. "My father, born and raised on a dairy farm in Benson, Vt., is a retired captain of the United States Public Health Service Commissioned Corps and a civil engineer. My mother was a full-blooded Kiowa Indian who grew up in Oklahoma. She also worked at the Indian Health Service as one of the executive secretaries in the Office of the Director.
"They impressed on me how they hoped their careers and work would make a positive impact on elevating the health status of American Indians. Their passion to serve the underserved influenced me to consider a career in medicine and follow in their footsteps."
Working during high school summers at the IHS led to him being introduced to Everett Rhoades, the first Native American Director of the Indian Health Service and also a member of the Kiowa Tribe of Oklahoma. That short conversation helped inspire Bartholomew to become a physician.
"He took a genuine interest in me and my career aspirations," says Bartholomew. "He spoke to me about health disparities and the need for health-care providers in Indian Country. He encouraged me as a Native student to consider a career in medicine. That brief interaction had a profound influence on me and my decision to pursue medicine."
Attracted to "Dartmouth's strong Native American program and rural setting," Bartholomew says receiving the Indian Health Service Scholarship and additional scholarship funding from the Medical School while at Dartmouth opened up new experiences that affirmed his passion to improve health care for those who struggle.
"The IHS Scholarship, which is similar to the National Health Service Corps', was one of the best medical school funding decisions that I have made," says Bartholomew. "Entering medical school, I knew I wanted a career in American Indian health. My IHS mentors encouraged me to consider starting a medical career in the Navajo or Alaska areas. Along with the additional scholarship aid from DMS, the IHS Scholarship eased the stress and financial burden, which I'm grateful for. The scholarship support and my overall medical school experience allowed me the opportunity to explore careers in medicine and public health and choose a career path that could be beneficial to improving the health status of American Indian and Alaska Native people.
"Scholarship support is especially important to students who want to pursue primary-care careers."
After completing his pediatrics residency, Bartholomew and his wife, Margaret Talley Bartholomew, a graduate of the Dartmouth Pediatric Residency Program, headed to Fort Defiance to provide much-needed care within the Navajo community. While he was well aware of the health statistics, there was no substitute for seeing conditions in Native communities firsthand.
"The health issues I had only heard and read about were now right in my face," he says. "Seeing the conditions and the challenges up close was a career-changing event."
Bartholomew enjoyed the hands-on clinical medicine and describes his time practicing on the Navajo reservation as "the best experience of my career . . . one I will never forget." He and his wife also served as co-clerkship directors for the DMS/Geisel pediatric rotation at Fort Defiance.
But while he was making a difference with his individual patients' care, he wondered how he could do more to improve American Indian health on a larger scale. By asking bigger population health questions, he helped increase access to and delivery of fluoride varnish treatment to the community, and started an assessment of community fitness resources, a subject Bartholomew knows well, as he's now training for his 10th Ironman Triathlon.
"Like a lot of Dartmouth Medical School graduates, I asked myself how can I make the biggest impact for the largest population of people . . . the biggest bang for the buck, so to speak.
That question led him to apply for the Centers for Disease Control and Prevention's Epidemic Intelligence Service (EIS) training program, a two-year postgraduate program of service and on-the-job training for health professionals interested in applied epidemiology.
"The EIS program provided an amazing experience. I was able to participate in and lead some interesting investigations of infectious disease outbreaks," says Bartholomew, adding that there are several distinguished EIS Alumni from Dartmouth's medical school, including John Modlin, Ford von Reyn, and Kathy Kirkland, among others.
After his CDC training, Bartholomew decided to return to the Indian Health Service headquarters in Rockville, Md., effectively coming full circle back to his family's service roots. He and his wife now live in Maryland with their three children, Isla, Lachlan, and Harper.
"The mission of IHS is to raise the health status of American Indian and Alaska Native people to the highest level possible," says Bartholomew. "Our division leads infectious and chronic disease epidemiology efforts, as well as prevention and control activities. I strive to do the most good for the most people, so this is a dream job, of sorts."
It's a big job, given the striking health challenges American Indian communities still face.
"In the United States, there remain shocking health disparities and inequities," he says. "As health-care providers, we have the ability to address these disparities and tangibly help those in need. For a truly rewarding and powerful experience—medically, culturally, and spiritually—premedical students, medical students, residents, and other health-care providers should consider working in American Indian and Alaska Native communities."
Dartmouth and Hanover remain close to Bartholomew's heart for many reasons, the biggest being that it's where he met his wife. Another is Dartmouth's founding mission to improve the lives of Native Americans. "It means a great deal to me, not only as an alumnus but as a Kiowa Indian, that Dartmouth and Geisel are upholding their commitment to Native Americans, and helping improve the health care of American Indian and Alaska Native people," he says.
"We should never forget the obligation that we have to Native Americans. That commitment—the word—is sacred."