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Natalie Cairo had some idea of what she was getting into when she requested an Advanced Pharmacy Practice Experience (APPE) at Wind River Family and Community Health Care in Wyoming.

She did what many fourth-year students in Auburn’s Harrison College of Pharmacy (HCOP) do: Talk to a friend who completed the same experience during pharmacy school.

In their fourth (P4) and final year, students complete the college’s APPEs, which consist of eight five-week rotations at various pharmacy practice settings in Alabama and beyond.

APPE rotations allow students to apply the knowledge and skills learned in the classroom to actual patients in real practice settings. There are required and elective rotations. Over the years, the college has developed an affiliation with the Indian Health Service in Montana and Wyoming, providing students with an elective rotation opportunity on Native American reservations.

When the former pharmacy student had “nothing but amazing things to say” about spending time in east-central Wyoming, serving two Native American tribes, Cairo knew she couldn’t pass on the opportunity.

“I believed the experience would push my professional and personal limits,” she said. “I believed it would offer a diverse patient population that would broaden my patient-interaction skills, as well as expand my empathy. I also believed this patient population was long overdue for equity in care.”

Wind River Family and Community Health Care — Wind River Cares for short — has clinics in Ethete, Arapahoe and Riverton, Wyoming. Each location serves the needs of Wind River Indian Reservation residents, as well as “any person belonging to one of the over 574 federally recognized tribes as an enrolled member or descendent,” according to the Wind River Cares website.

The reservation’s more than 2.2 million acres is home to the Northern Arapaho and Eastern Shoshone tribes.

Experiencing Wyoming

Briley Graves, who completed the rotation with Cairo last fall, sought Wind River Cares for similar reasons.

“Professionally, I saw it as an opportunity to serve a unique population to better inform my ability to practice patient-centered care with diverse populations in my career,” said Graves. “Personally, I wanted to get out of my comfort zone and live in a new area of the country to help develop my sense of independence and maturity.”

Before going out west together, Cairo had completed rotations in Mobile, Alabama, and Pensacola, Florida, while Graves accomplished training in Huntsville, Alabama. Wyoming would be different.

Cairo was excited to grow personally and professionally, but also “a bit nervous” as the way of life in Wyoming would be vastly different for a native of Chicago’s southside. What helped, though, was reading the blog posts from previous students. HCOP requires P4s to maintain a blog during an Indian Health Service rotation.

“I felt like I knew what to expect, but then I got to Wyoming and realized there are truly no words to describe the beautiful state and experience,” she admitted.

Yes, the vastness of Wyoming and its varied climate can be a shock to any Auburn student, but this rotation met every expectation for Cairo and Graves.

Graves recalled arriving in Wyoming last October as “quite harrowing,” as a portion of the state was experiencing a forest fire, an event “we don’t see much in Alabama.”

Cairo said they were initially overwhelmed by the newness of it all — “Wind River Indian Reservation was unlike any place we had ever lived” — but it didn’t take them long to develop a routine.

Living in the small community of Fort Washakie, the duo had a 10-minute drive to the Ethete clinic, where a typical day consisted of performing medication reconciliations, counseling patients, filling prescriptions and working on various projects. They did similar work at the other clinics.

Outside of work, students are encouraged to explore the area. Cairo and Graves took full advantage by hiking, exploring and visiting area attractions, such as the grave of Sacagawea, the Lemhi Shoshone woman who helped Lewis and Clark on their American expeditions. Her cemetery is on the Wind River Indian Reservation.

We got next

Classmates Tom Minshew and John Abrams are currently in the midst of their rotation at Wind River Cares.

Like Cairo and Graves, Minshew gravitated to the chance “to live someplace new and serve a specific population.” It helped that his good friend Abrams was interested.

Also like the women, the men sought advice from previous students. But Minshew said he didn’t talk to anyone who went to Wyoming during January and February. While he received advice on the essentials to bring along, hopefully, someone advised both on what to pack to experience a true winter.

Coincidentally, Auburn experienced its first snowfall in seven years on Jan. 21. With about an inch and a half of accumulation and freezing temperatures, the university switched to remote learning for most of the week. 

Wyoming, on the other hand, averages between four and 22 feet of snow annually. Abrams believes they have received nearly a foot since their arrival, much less than local folks expected, so far. It’s been enough, though, for the pair to spend time snowmobiling in and around Yellowstone National Park.

A little Auburn in Wyoming

Pharmacy students rotate in and out of Wind River Cares five times a year, but at least two Auburn people are always there.

Katherine (Baker) Plunkett, a 2019 pharmacy alumna, works at the Ethete clinic and is the preceptor for Auburn students. A preceptor serves as the primary instructor and role model to students.

Her former classmate and husband, Gray Plunkett, works at the Riverton site.

Katherine didn’t experience Wind River Cares as a student, but Gray did. In fact, Katherine said he and another classmate were responsible for reestablishing Auburn’s longstanding relationship with Wind River Cares, solidifying the opportunity for future Auburn students.

Wyoming and Wind River Cares were so significant to Gray that he was determined to return. To be sure of this, Katherine said he only applied for a Wyoming pharmacy license upon graduation.

When Gray moved out west that summer, Katherine went to Mississippi for a yearlong residency program. Once that was complete, she said she “looked for a clinical job in a unique setting, and Wind River Cares fit the bill perfectly.”

It was ideal to collaborate with her husband, but, for Katherine, the pull to Wind River Cares was more about how it serves its community. By having pharmacies inside its clinics, Katherine said pharmacists and other medical professionals collaborate more easily and provide patients with continuity of care.

“Our rotation allows students to experience a unique clinic system and interact with a particular population,” she said. “Our close-knit clinic provides an excellent opportunity for interdisciplinary interaction and genuinely enables students to become part of the pharmacy team.”

Life on the reservation

For pharmacy students, the daily routine is varied. Katherine said they are generally given one or two longitudinal projects that assist the pharmacy or clinic. Their time otherwise is spent in day-to-day activities, so they experience the workflow of the pharmacy and clinic as much as the rest of the health care team.

“Students are encouraged to interact with providers on clinical questions, counsel patients on new medication initiation, answer patient questions and get involved in the pharmacy workflow,” Katherine said. “We also like to engage the students in community and public health events. Participation in community vaccine clinics or health fairs has allowed students to experience our patient population more personally.”

For Cairo, her time in Wyoming was memorable not only for the “breathtaking landscape I saw every day, but for the exceptional people I met” and how it all fostered her personal and professional development. 

“I am so blessed that I was given this opportunity through HCOP. I will never forget it,” she said.

For Graves, who is seeking a residency in the Mobile-Pensacola region after graduation in May, Wyoming showed her how to achieve a healthy work-life balance.

“Throughout pharmacy school, it’s easy to get bogged down in the day-to-day, but being at Wind River showed me that the career ahead can be rewarding and balanced with wanting to pursue other experiences to cultivate my own wellness,” she said.

“Additionally, apparently, you should never touch the bison. While cute, they can be deadly.”