‘I went into medicine to help my community’: Nez Perce doctor speaks on rural health care and building a future for the next generation

When Dr. Kim Hartwig first decided she wanted to become a doctor, she was 13 years old. Hartwig’s older sister, a national-level basketball player on an Amateur Athletic Union team, had torn her ACL and Hartwig remembered being marveled by her sister’s recovery.

“She played like she wasn’t ever injured and I was just amazed at that recovery and attributed her success, her full return to the court, to the doctor,” Hartwig said. “So, I was going to be a doctor who fixes little girls’ knees so they can play basketball.”

Hartwig, a 1991 Lapwai High graduate, didn’t know any Native American doctors growing up. However, her connections to her family and community would continue to be a driving force in her career.

Now she is the director of Nimiipuu Health in Lapwai, Idaho. Hartwig is setting an example she didn’t have growing up. In some ways, not knowing just how hard the process would be, helped her to get through it, she said.

“It’s like when you first run a route that you don’t know. It’s not as challenging the first time because of the unknown. But when you go the second time, you know how much longer you have and you know where the hill starts,” she said. “So, I think that naivety really helped me to not — not fail myself.”

For many Native students and kids from small towns, Hartwig said, leaving behind a powerful support system is a big challenge when they go to college.

Hartwig attributes a large part of her success to the people she connected to away from home — her college basketball team and other Native people she met.

“My junior year at Loyola Marymount, I attended an elders gathering with our Indian club, and I realized when I arrived I hadn’t seen anybody that I knew,” Hartwig said. “But I felt this immediate sense of warmth and knew that I needed to have my Native community around me.”

Hartwig applied to three medical schools, all of which had Native American centers of excellence. She ended up at the University of Washington, where she participated in the Washington, Wyoming, Alaska, Montana and Idaho (WWAMI) medical program.

WWAMI connects medical students to rural communities in the five states, including places like Hartwig’s hometown of Lapwai. Returning home was always the plan, she said.

“As a physician, I could be anywhere. It’s a very versatile field,” she said. “But I went into medicine to help my community.”

While in her first year of medical school, Hartwig got pregnant. In some ways, she said, it was easier to have a baby in school rather than after. In her residency, there were 20 people to help pick up extra work instead of the six doctors at her first practice.

Still, it was a challenge. When Hartwig returned to school, she said, many of her professors were surprised to see her.

“I was a Native student in medicine, which they didn’t have very many of, and I had a baby. When they gave me my exam, they were like, ‘Oh, we didn’t think you were gonna show up,’” she said. “I was like, ‘Well, I’m here, though you don’t know who I am. Can I have my test?’ And my daughter was sitting with me through all of my finals that year.”

After having her first daughter, Hartwig took a year off from school. When she returned, she went into a meeting with administrators to talk about her plans. She only later learned why they had called that meeting.

“They were deciding whether I can continue school or not,” Hartwig said. “And I had no idea.”

Hartwig continued on and had two more children while in school. When she started practicing, she said, the experience helped her be a better doctor. She was equipped to understand the realities of family life that her patients dealt with.

“Like, seeing a kid with bruises on the front of their shins, not immediately jumping to some sort of abuse, but ‘That’s an active kid that likes to climb,’” she said. “Understanding the social dynamics that impact health care that a lot of times you don’t understand without having the responsibility of a family.”

Balancing physical, spiritual and emotional health is an important part of Hartwig’s approach to wellness. She just turned 50 last year and still plays in a summer basketball league.

“That’s really where I feel like life flourishes,” she said. “That’s really what we’re trying to do in medicine.”

Hartwig brings the same holistic approach to her work at Nimiipuu Health. It translates to a wide array of wellness programs and an investment in building trusting relationships with patients.

Keeping doctors in rural and reservation towns can be a challenge, Hartwig said. Many who seek jobs at reservations are there because they can get student loan repayment through Indian Health Services.

That can make Native health centers a “revolving door” for early-career doctors. So, one of the first questions new providers are asked, she said, is how long they plan to stay.

“Those two initials after your name don’t mean a lot in our community. You’re here to provide care,” she said. “The privilege that it is, for us, to provide care — we need to remember.”

Hartwig said for doctors who stay there is a big reward. When providers take the time to earn their patients’ trust, word gets around.

“When you have a good experience in the clinic, the auntie will go home and tell her sisters or her brothers, and then people will start coming asking for that provider,” she said.

Part of rural and Native health care is fostering the next generation of providers. Some programs, including WWAMI, help bring more students, and eventually doctors, into rural communities.

Native doctors like Hartwig are still few and far between. Another Nez Perce doctor, Hailey Wilson, currently works in a tribal community in Arizona. There aren’t many.

It is something that Hartwig thinks about, especially as she looks to the future, who might eventually succeed her as director. Hartwig said she and her colleagues are trying to open the door for a future where the clinic might see more doctors from its very same town.

“We have some discussions going on now with Oregon Health Sciences (University) to develop a pathway,” she said. “We just need to let our kids know, it’s doable. I was naive in my ambitions, but now they have a tangible model for them to know that it can be done.”

That investment in the future is important to Hartwig. She takes time in her appointments with kids, letting them listen to their siblings’ heart through a stethoscope or look at their throat.

“Those things are really important for kids to know that, that’s not something that’s off limits,” she said.

Hartwig said being a healer goes beyond treating physical ailments.

“For Nimiipuu Health to be a true place of healing we can only heal ourselves first,” she said. “That’s my ultimate goal, is for our community members to be able to heal.”

Hartwig’s patients, and her own family, have much to heal from; be it forced assimilation and loss of language, which happened to Hartwig’s own family, or a loss of bodily autonomy for Native women at the hands of IHS doctors.

When she returned home to Lapwai four years ago, Hartwig said, there was still a building standing in town where tribal members were forcibly sterilized.

“I didn’t realize that, that was why all of these grandmas,” she said speaking of local elders. “That’s why they didn’t have children.”

Hartwig said her being here despite those hardships speaks to the strength and wisdom of her ancestors, who foresaw a need for housing, health care, education and hunting rights written into treaties.

Now, Hartwig is working to build a brighter future, strengthened by what she and others had to go through.

“All of their work and sacrifices, that’s why we’re here and our job is to prepare for, even when we cross over, that people are still here with health and have an identity in our culture.”