Rocky Boy Health Center Prevention Department Pharmacist Gary Palladino

Gary Palladino works in the Pharmacy at the Rocky Boy Health Center at the Chippewa Cree Tribe in Rocky Boy Montana. Gary shares on what its like to work in Rocky Boy as a Pharmacist and what he experiences.

Transcript

SPEAKER_01 0:00

Just kind of, you know, we're such a tight-knit community. We're really just family here. So it's nice to, you know, kind of get the word out, get to, you know, know other people, see people face to face. You know, I know it's uh it's been a while. So yeah, thanks for having me.

SPEAKER_00 0:12

Yeah, I'm glad uh I'm glad you decided to join us. And yeah, we have a lot of different departments with the center, and um and but I'm really glad that you decided to take part. And I know you're um been working as a pharmacist. Um, how long have you been in uh as a pharmacist working at Rocky Boy?

SPEAKER_01 0:30

So I've been a pharmacist for the past seven years. Um, essentially my whole uh tenure as a licensed pharmacist has been with Rocky Boy. Um so I kind of started my pharmacy journey though um about almost 20 years ago. So I started back in pharmacy back in about 2007, uh serving on active duty in the military. And uh after a couple years, after I got my honorable discharge, I knew I wanted to do pharmacy. So I got accepted into pharmacy school. And then about halfway through pharmacy school, um, I took a summer internship with Indian Health Service. I'm just working at kind of a small outpatient clinic, kind of similar to ours, except it was in Oklahoma. And I just fell in love with the small community, um, and I felt like it was actually making a significant difference in people's lives, but not only just making a difference, just being able to make those personal connections that you don't have in like larger facilities where you know patients are sometimes uh unfairly treated just like a number, you know, or a patient case, you know, or a chart number. Um, but like just knowing patients, just knowing their stories, learning more about them, what really matters for them, um, was just really cool. And I knew I'm from a small community myself on the East Coast, um, probably about maybe about 30,000 people nowadays, um, but still pretty small. And uh so I always knew I wanted to give back to a small community. I initially thought that was going to be more um serving back in the military, not necessarily back in active duty, but just serving other active duty people. Um when people think about the military, you think, you know, especially in the United States, you think it's like, you know, this massive force, but it's really only about less than 1% of the entire U.S. population. So it's technically, you know, even though we're really spread out, it is a very small community in itself. Um, but then God, I felt like had other plans. And I was offered a job here at the Rocky Boy Health Center um shortly after pharmacy school, and I just couldn't turn down the opportunity to really continue the journey. I started in pharmacy school. So I'm glad to be a part of this place.

SPEAKER_00 2:27

Wow, thanks. I I guess first of all, thanks for your service and uh with the military. And I think we're the Rocky Boy Health Center and the community of Rocky Boy is fortunate to have you join on. And um, as soon as you got credentialed and got all that going, and yeah, we're we're a small community. I think it that I think it does make a big difference to know uh know your um population and know who's coming in, and it's really good to get to know people. You know, we are this is uh rural and um in terms of uh rural, I think they call it a frontier rural because uh we're so sparsely populated here. Yeah.

unknown 3:02

Yeah.

SPEAKER_01 3:02

Yeah, no, you guys uh I consider you guys my Montana family. Um just because like I've never been. This is the first time I was actually in Montana, just you know, um working, you know, for Rocky Boy Health Center on site for a while. And uh yeah, you guys have just been phenomenal. Like I said, just been just this connecting force and just really I can't use any other word to describe it, but family. Um I'm Italian American, so family is like many cultures, very, very central to just your you know overall well-being. So just like having that family connection has been wonderful. And like I said, I'm grateful to be part of you guys.

SPEAKER_00 3:37

That's really awesome. So you know, looking at some of the content we were talking about, I sent you some questions, and I know that some of them are just like um different ones, but uh in terms of um community in Rocky Boy, the conditions, like what what kind of conditions do we typically see where um people are coming in for medications? That's um generally speaking.

SPEAKER_01 4:01

Yeah, so um I know we treat a wide variety of conditions here. Um, but I would say just looking at just the overall the amount of medications we are dispensing, I would say the main two ones are diabetes and hypertension, so high blood pressure. Um this is specifically type 2 diabetes. We do have you know several type 1 diabetics, but type 2 is uh overall the you know most prevalent. Um and then, of course, secondary to those are um cardiovascular disease and chronic kidney disease. Um they rarely present as separate conditions, um, and they're usually a result of worsening diabetes and hypertension. So there's like, you know, of course, diabetes, hypertension, but then a whole nother list of conditions that you know almost like funnel out of those two, um, depending on how well controlled you are or not. Um I feel like this is pretty on par with the rest of the United States, though, where um type 2 diabetes and hypertension um I think uh combined make uh about over 50% of the adult population, so pretty huge uh nationwide. Um I also feel like here, which in a good way, behavioral health is finally starting to become a primary focus. Um people have had substance abuse issues, depression, anxiety forever. Um, this is not like a new issue, um, but it was often stigmatized and really screened for in healthcare. Um the more we screen for these conditions and treat for them, um it's we should really treat them really no different than diabetes and hypertension because they are disease states, chronic disease states. Um and the closer we get to improving the overall health and well-being of each patient we encounter, you know, the better, you know, off patients are going to be. So I feel like just um specifically for this community, I think, you know, just um mental health is you know um very prevalent, but prevalent, like I said, in a good way, not necessarily because this community has a lot of mental health conditions. I think it's just because we have so many resources with, you know, behavioral health on site and stuff like that. Um, the MAP program, just so many resources to screen for these patients and also give them the treatment they need. So, like I said, I won't necessarily call it prevalent, but just something we're able to, you know, really um capture on and really make a good impact overall to patients' health and treating it like an actual chronic condition, like it should be.

SPEAKER_00 6:12

Yeah, I really um appreciate how they integrated uh substance abuse with behavior health and they reorganized, and it's really I think it sounds like it's really working out good and uh it's something that's new. And uh I think they really take a practical approach to working with um the whole spectrum of uh you know families, uh individuals. No, really everybody. So I I like uh Wapakesic department and how they're functioning.

SPEAKER_01 6:39

Yeah, absolutely.

SPEAKER_00 6:41

And particularly the MAT program. I know we've had um I think in the early stages of our podcasting, we did a MAT uh focus and we talked to some people and uh so I'd like to invite them back too to come back over and share more because it's really um it's growing and um our services are just really outstanding over there with behavioral health. So in the MAT program.

SPEAKER_01 7:04

Yeah, absolutely. Like and like you mentioned too, just uh Mike, just like kind of integrating that whole focus too. It's just like really connecting patients um to the resources we do have. So if a patient happens to be in for diabetes, but you know, we should, you know, also screen them for you know behavioral health conditions and like get them connected right then and there too, because you know, patients um are you know no different than you know yourselves. I mean, they they have their own lives, they're they're busy, they have their stuff. So it might be another three to six months before you see them again for just you know what they're traditionally in there for. Um, you know, it's a huge disservice to not, you know, overall screen for what else is going on. We may not get you the help you need right then and there, but at least we could get the ball rolling, connect you to those services. That way we're getting everything about you treated versus like just coming in for one thing, then you have to wait another six months to treat another thing. So just like I said, just really integrating, you know, um behavioral health in with just your overall um disease states as well, too, is is really good that we do here.

SPEAKER_00 8:05

Yeah, I'm a big proponent of uh early early screening and just getting as much information as you can because you never know um what uh people might share that can um you know lead to other things to address in in early stages or middle or even late.

SPEAKER_01 8:19

Uh yeah, absolutely.

SPEAKER_00 8:22

Uh okay, so I have another question. Um Are there any barriers to um prevent patients from adhering to medications?

SPEAKER_01 8:33

So I would say there's um two very prevalent barriers out here, and the two main ones are transportation and I would say health literacy. Um overall, you know, patients can't take medication, they physically don't have you know in their possession. So like if they can't get rides to the pharmacy, if someone brings them to their appointments regularly, um they you know can't take their medication. And of course, patients don't want to take medications they don't understand. So those to me are kind of the big um barriers, and they're both incredibly valid. Um, and you know, they're not at all on the patient. Um, it's been definitely an uphill battle just in healthcare in general to you know eliminate these barriers. Um, I think transportation and CHR do a phenomenal job of bringing patients to their appointments, uh delivering medication with a really well-connected community. And keep in mind, too, like you mentioned, we're very rural sites, so like sometimes like we'd have to transport patients all the way to Great Falls to you know their appointments for specialty care, you know, certain exams, stuff like that, that we don't have the capabilities in the local area to. Um, but even if we double the staffing really of you know both uh you know transportation, CHR, um, I still don't think we'll completely eliminate these barriers. Um so I mean the same goes for health literacy. Um some patients are only seen by a provider for maybe 15 minutes or less, and then they pick up their prescription and they're on the way home in a short amount of time. Um again, we could double the staffing of medical and pharmacy, which I think would certainly make a difference to the amount of time we get to engage with our patients, but we would still never fully eliminate this barrier. Um, I don't think there's like a perfect solution to solve either of these. I mean, this is like I said, not just here, this is also issues, you know, barriers to care just nationwide. Um, but I think that's the important, like you mentioned earlier, just working like integratively, collaboratively as much as possible to share ideas and develop joint solutions to these barriers, because like something that seems just from a medical standpoint, something that seems very trivial, like you know, transportation to us, because we're so focused on you know the patient's healthcare, medicine adjustments, stuff like that. But it's like if transportation like you know isn't unable to bring this point patient to their appointment, like everything else like falls apart. So like every person plays a part. So like, and it's huge to integrate those. So I think, like I said, just regularly meeting, pinging ideas off each other, um, just how overall we can, you know, fix the system essentially, um, I think is a great start, and it's a blessing to just be, like I said, a part of a um centralized location where you have all these departments all essentially under one roof or in very close proximity.

SPEAKER_00 11:22

Yeah, I I think transportation really does a good job uh picking people up, taking them around because they they service a lot of a lot of um a lot of area in terms of our population. And we have you know, I think we have uh roughly about 800, 900 households here, and so they have a lot to do, and so it's really good to see them working with our clients. And and I know you mentioned the the health literacy. That leads me to another question about um you know communications with uh NATIO or Ojibwe uh speakers. Um I don't know if that's ever been an issue, but have you ever had a translator for no somebody that uh speaks Cree mainly and then having to explain things? I know they have a little room there where you can talk to people.

SPEAKER_01 12:05

Yeah, so I haven't come across any issues where I specifically need a translator, and I think not saying you know patients don't come in um preferring to speak their native language, which you know I absolutely encourage. And I think it's wonderful that you know you guys have you know um creed classes you're teaching, especially to like integrate that to like the the younger generation, which like I feel like just over across the board, um that's like a lost art, just like learning your language and stuff like that. I can only speak a handful of Italian myself when my grandparents, my great grandparents on both sides immigrated from Italy and like you know, fluent Italian. Um, and then like I feel like a little bit that gets lost each generation. So that's just so really important to just be connected with your culture. And one of the most important things is just that language. Um, so I think that's that's beautiful that that's you know able to get kept up here on a regular basis. Um, but back to your question. I no, I haven't had uh to use a translator, um, but I think technology also plays a huge role in this because we have um various video demonstrations. We have the option to physically demonstrate how to use certain medications, like some of the um inhalers or some of the injectable devices. I know can get pretty complex these days. Um, it's a great way to you know administer medication because you know you're not having to necessarily come in to see a provider, you can do it at home. Um, but you know, we're able to demonstrate these. We have sample devices in the pharmacy we can show a patient out to. Um, oftentimes, too, we've had patients that you know are not really comfortable doing the first you know dose themselves. So we kind of talk them through it, show them you know demonstration videos and stuff like that, and they're able to kind of administer the first dose themselves. So just kind of taking almost language out of it and more just like focusing on that the visual aspect of it, which everyone's going to you know understand regardless of what language you speak. I think it's been really helpful and not needing to, you know, overcome any type of language barriers.

SPEAKER_00 14:05

Yeah, that sounds really practical, helpful, and um, yeah, visual is really the key, and I think that's what most people can cue in on. Um, yeah. So what do you like most about working in the pharmacy with the Rocky Boy Health Center?

SPEAKER_01 14:21

So I know it's just um like we kind of hit on this a little bit before, just really just being part of a family. I mean, that's really what it is. Um, just being so connected to just, you know, not only the the other healthcare teams that I talk to on a regular basis, but just also the patients as well, too. Like, you know, um, I know majority of the patients I see on like a first name basis. Like I know personal stories about them. You know, they, you know, know about my kids, I know about theirs. So it's just like I think to me, that's you know, the biggest connection uh or biggest, you know, perk of, you know, kind of working in a place like this that's you know so interconnected and so such a huge emphasis on family and so welcoming as well, too. Um like I am not Native American, like I mentioned, I'm Italian American, but still just um being so welcomed in this community um is just you know, it just kind of melts my heart to just know I'm accepted here and just like doing my best to take care of everyone, but also just being respectful of you know and learning more about you know the um you know Rocky Boy's culture and everything else that's you know going around the community, I think is uh is really special about this place.

SPEAKER_00 15:28

Oh yeah, that's really awesome. Thanks. So we do have uh um Rock Chief Rocky Boy Day coming up in about uh two weeks, maybe the 17th, I think. And so we have a a day we're gonna do some uh honoring Chief Rocky Boy um on that Thursday, the day before the actual holiday. So uh I want to thank Gary Paladino for coming over virtually to share about his work at the pharmacy at the Rocky Boy Health Center. It's really cool to have you uh join us and talk about that. I know people are very busy, so I want to thank you for uh taking some time to share with us on what's going on. And you got the Italian last name too.

SPEAKER_01 16:04

Yeah, yeah, it's pretty, you just gotta say Paladino, and then you know it'll it'll click you gotta do the hand movement too. Very uh vocal with our hands. So no, I definitely appreciate the opportunity, Mike, to just kind of talk about, you know, just have a platform to talk about. I think your podcast is wonderful. Um, I've listened to a couple other podcasts. I'm this first time I've actually been part of one myself. Um, so you know, I think it's great just to get a bunch of different people on there, um, both, you know, community members, healthcare members, um, and slary services, you know, I just the more people we just get to highlight and just it's great just to learn more about people. It's you know, even when it's uh just someone you've you've heard their name constantly, but it's like, oh, that's that person. I know that person. So just being able to just either hear their voice or see their face, just like is able to just make that connection that much stronger and just realize, hey, you know, we all like you mentioned, we're all busy. Um patients are busy as well, too. But just taking a moment out to just, you know, you know, 15, 20 minutes to me is like you could always carve that out in the busiest of days, just to, you know, um focus on, you know, what really matters and taking a step back. The work is always gonna be there, that's never gonna go away, no matter what your job is. There's always gonna be work to get back to, but people don't really take time for community and family and stuff like that. And I think just little stuff like this, um, it's gonna make a huge impact, Mike. I think you have a great podcast going and hope it continues uh for a very long time.

SPEAKER_00 17:27

Awesome. Thank you very much. Appreciate all your words, and like I said, you know, thank you for joining, and I'm uh glad that you were able to join with us today.

SPEAKER_01 17:37

Yeah, absolutely. Thanks so much, Mike, for having me.

SPEAKER_00 17:39

All right, have a good day, and talk to you later, Gary.

SPEAKER_01 17:42

All right, take care.