Return to their Routes: Laurel and Jim return to Montana

If there is a theme in our trip, it is that many of our talented friends have established themselves in rural towns around this nation, often returning to the places where they were raised. After leaving the Turtle Mountain Reservation in North Dakota, we turned westward, beginning the long journey home. Fortunately the route took us through Livingstone, Montana, where our friends Laurel and Jim live with their two twin daughters, Nastia and Larissa.

Laurel Desnick and I have been medical school colleagues for many years, and for the past few years she has worked with me in the Rural Underserved Opportunities Program (RUOP), through which we introduce students to practices that serve disadvantaged popultions . Most of the sites where we send students are in remote rural communities, much like the ones Fernne and I have been visiting.

Laurel trained in internal medicine at the University of Washington, but at heart she is a family doctor, and indeed she sees not only adults but also children in her part-time practice in Livingstone. Laurel and her husband Jim Baerg hail from remote rural areas themselves, and moved to the small town of Livingstone many years ago where they married. Laurel later went to medical school after years as a house painter, and Jim used their time in Seattle to finish an architrecture degree. They adopted twins from the old Soviet Union, and we have been part of the extended network that watched, and tried to help, as the girls slowly recover from the devastating experience of having been neglected and abused in the orphanage from which they were rescued.

Livingstone is a charming and complex town, at once containing remnants of the flagging embers of the agricultural base upon which Montana was built, and also host to wealthy exurbanites who have traded in a city existence for the stunning beauty of the Montana landscape. Livingstone is only an hour from Yellowstone Park, which adds to its allure. But, as Jim told me, "you can't eat scenery", and for those without a profession or an inheritance it can be tough to make a go of it in this immense state.

Laurel represents the ability of many of the rural doctors in our five-state medical school to combine clinical practice and teaching, a combination that enriches both of these callings. Their dedication to their children and their community are steadfast and inspiring, and the warmth and ease of small town living remind me of the best parts of my own childhood in rural New Hampshire.

Another Family Comes Home: Dave and Phyllis Jollie and the Renaissance of the Turtle Mountain Chippewa Reservation in Belcourt, North Dakota

I met Phyllis Jollie when I hired her to work in the Seattle Office of the National Health Service Corps sometime around 1975. Her husband Dave had forged a very successful career with the Bureau of Indian Affairs, but like many government employees, he and his family were transferred every couple of years. To our good fortune Phyllis felt like she could go back to work after having the fourth of their daughters, and when Dave got transferred to Seattle she came and joined our team. Fernne also became part of this intrepid crew shortly after, and we had a truly exhilarating and rewarding time building primary care practices in small towns throughout the West.

I was a bit flabbergasted when Dave and Phyllis decided to ditch their secure and reasonably lucrative government jobs to return to the reservation of their birth, the Turtle Mountain Chippewa Reservation almost at the Canadian border in central North Dakota. Home was calling, they told me, and they wanted their girls to grow up in the midst of their family and their people. And so they went. We always kept in touch, and found out that they had opened the first supermarket in Belcourt, North Dakota, the town that is owned and managed by the Turtle Mountain band of Chippewas, a tribe whose roots are in North Dakota, Minnesota, and Wisconsin.

We kept in touch with the Jollie family over the years, and hung the yearly calendar they sent us in our Okanogan Cabin, wondering what the scenes from Indian life really represented in the lives of our friends. When this road trip materialized, we decided to find out, and drove the hundreds of miles to a state and region we had never seen.

Driving into Belcourt was a surprise. Unlike the Colville Reservation with which we have worked and where we have travelled for many years, Belcourt seemed to be a flourishing and busy town. The Jollies lived in a beautiful house on a hill in the center of town, about a two minute drive from their mall - it turns out they had bought the entire mall when the previous owner foundered several years after they opened their supermarket. Not only did they host an impressive number of shops inside the mall, but they were heavily involved in almost every aspect of the town. Their most recent accomplishment was to open the first full-service bank in Belcourt, and the first Indian-owned bank in the country, surmounting decades of resistance from bankers in the non-Indian towns near the reservation.

But strong as their commercial ventures had become, their family was even stronger. All four of their daughters with their husbands and children, had moved back to Belcourt. Three worked in the family business, and one was a clinical psychologist in the mental health center. Wherever we went - the impressive college that the tribe had built, the clangorous casino, the Indian Health Service hospital with a full staff of doctors, several from the tribe - we met members of their extended family. The warmth and respect among them could be seen in every gesture, and heard in every word, no matter how mundane. To our eyes, Dave and Phyllis were the foundation stones of both a remarkable family, and the engines behind the renaissance of the most successful Indian reservation we have visited.

Not that all is roses and honey. The Chippewas have the same struggles with alcohol and drugs as other indigenous people, and wrestle with the high rates of unemployment that come from being a very small place far from any commercial center or rail head. But it was inspirational to see what a few determined people could do catalyze change, and how a family can maintain its integrity and mutual support despite the enormous strains of living in a remote and at times hostile environment.