September 01, 2016
Area(s) of Interest: Physician Leadership Family Medicine
|Robert E. Hertzka, M.D.
Eva Marie Smith, M.D., MPH, a Hoopa family physician, provides medical care to the Hoopa Valley Tribe located in a remote section of Humboldt County where poverty, substance abuse and domestic violence are common, and resources to address these problems are slim.
The Hoopa Valley is approximately 50 miles from Eureka on winding roads. On a good day it can take a patient an hour to go to a specialist or a visit the hospital. Here, where the Klamath and Trinity Rivers meet and where the Hoopa have fished the rivers for salmon since time immemorial, Dr. Smith, a native American member of the Shinnecock nation, practices medicine at the K’ima:w Medical Center with her husband, Emmett Chase, M.D., a Hoopa tribal native. She is the center’s medical director.
Because the reservation is remote, her practice consists of everything imaginable from managing COPD to heart attacks to gunshot wounds to pediatric care to substance abuse to helping patients to manage diabetes. While there are no specialists on the reservation, she has single-handedly brought University of California, Davis telemedicine services to the medical center to give her patients access.
In a throwback to another era, Dr. Smith makes frequent house calls, sometimes driving more than 60 miles a day seeing patients. “Working in Indian health means dealing with social services as well as medical services,” she says. “When you are in the home, you get the whole context” for a medical problem.
You may be treating an older woman for diabetes, she said, who is not following your instructions. But, if you make a house call you realize there is a whole lot more going on. She may be a grandmother that is taking care of a lot of grand kids. “I may be frustrated that her blood sugar is out of whack,” she says. “But taking care of herself may not be her first priority.” House calls allow Dr. Smith to understand her patients.
Not only does she take care of individual patients, but she also takes care of the Hoopa nation when a public health emergency emerges. Take for example the hazards of living in a forest valley. In1999, the community spent one summer indoors trying to avoid a blanket of smoke from a forest fire that raged in the valley for three months. Because the tribal lands are considered an autonomous government, the need arose during this emergency for a public health officer to liaise with the county public health officer, the tribe and the state. Dr. Smith took on this roll. She got the tribe’s air quality monitors going, took accurate particulate matter readings, looked at wind readings and the course of the fire, and determined the appropriate response overnight. She liaised with the county health department, and in the case of this fire (there have been many others), she helped the tribe and county declare a state-of-emergency – the first state declaration ever based on a threat to human life.
In addition to medical care, Dr. Smith, also treats her patients for substance abuse. She is certified in addiction medicine through the American Society of Addiction Medicine. Substance abuse, she says, is a regional problem, not just a problem on the reservation. Methamphetamine and opioids are the drugs of choice. She finds treating substance abuse particularly satisfying because it allows her to bring in spirituality to the treatment, she says.
Her work is varied and always exciting, she says. “Medicine is a good life, if you like people,” she says smiling. “I love people.” She says she has spent the bulk of her life in small communities just like Hoopa.
Dr. Smith is a graduate of the Georgetown University School of Medicine in Washington, D.C. She did her residency in family practice at Brookhaven Memorial Hospital Medical Center, Patchogue, NY, and her preventative medicine residency at the University of California, Los Angeles. She is a diplomat of the American Board of Family Physicians.
Dr. Smith was the 2013 recipient of the California Medical Association's (CMA) Frederick K.M. Plessner Memorial Award, which honors a CMA member who best exemplifies the practice and ethics of a rural practitioner.
The award video is available on CMA’s YouTube channel, www.youtube.com/cmadocs.