American Indian health care at core of Wyllie's world: Doctor's work shaped by her own illness and love of family heritage. (Profile).

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FOR DAWN WYLLIE, MD, MPH, the year 1961 marked a point in her childhood that she will never forget.

It was a year of illness and injury that, ironically, helped propel her down her life's path. She was an active 6-year-old living in San Francisco's ethnically rich Mission District that year when two health scares landed her in the hospital: pneumonia and a serious fall from a swing.

Wyllie remembers her pediatrician as a dear man who spent an extraordinary amount of time with her when she was critically ill with the pneumonia. As Wyllie recovered, he took her to visit the hospital lab and described how the department worked.

She remembers him involving her in her own medical care, explaining everything to her. Even though she was only in first grade, he made her understand what was happening. She wasn't afraid--thanks to her doctor.

"In those days doctors made house calls, too, and I remember him making a house call just before I was admitted to the hospital. He was my early role model for a doctor," recalls Wyllie, 46.

Later that year, she suffered a deep gash in her chin when she fell from a swing. She was rushed to St. Luke's Hospital in San Francisco, where she had to have stitches and plastic surgery.

While in the pediatric ward, she was bound up in a straitjacket--a common practice in those days--to prevent her from scratching her stitches. She wanted out of the restraint. Strangely, it was in this moment of great helplessness that Wyllie first learned of life's great possibilities.

"I said, 'Nurse, can you come take this off? I promise I won't scratch my stitches.' And she said, 'Well, no I can't; only your own doctor can do that. And I'm not a nurse, I'm a doctor.'

"At that moment a light bulb went on and I realized that I could be a doctor. I had never met a woman doctor, and I didn't know that women could be doctors," Wyllie recalls.

Today, Wyllie is something of a trailblazer in medicine herself.

She is the chief medical officer and deputy area director for the Bemidji (Minn.) Area Indian Health Service. This office manages a budget of $230 million for the region, which covers 34 tribes, five urban programs, and about 90,000 beneficiaries in Minnesota, Wisconsin, Michigan, upper Indiana and Illinois.

Wyllie oversees resource allocation, policies and procedures for the Minnesota office, directly manages a staff of seven, and serves as a medical liaison to federal and state agencies regarding Indian health affairs. Wyllie is herself of Sisseton Dakota heritage.

The Indian Health Service is one agency within the Department of Health and Human Services, a system that hires federal employees as commissioned officers and civil servants.

Like one of her role models -- her Aunt Peg, who was a pioneer career women and served as one of the first women lieutenant commanders in the U.S. Navy during World War II -- Wyllie wears the uniform of a commissioned officer. She's a Captain 06 (equivalent to Navy rank) and her uniform has four stripes.

Last December, Wyllie flew to Washington, D.C., to receive a public health service medal for her Indian women's health initiative work and for general leadership in Indian Health.

Indian summers

Growing up in a melting pot such as the Mission District in San Francisco was nearly as powerful an influence on Wyllie as those childhood hospital stays. Her friends and neighbors were Hispanic, Chinese, American Indian and every other ethnicity imaginable.

The family moved to Almaden, Calif., in south San Jose, when she was 11. In those years, the area was known more for agriculture than computer chips and Wyllie remembers the beautiful vineyards, orchards and dairy farms just three blocks from her home. Her parents divorced when she was 14 and she remained living with her mother and sister.

During summers and vacations from school, she traveled with family to Northern California, where her grandparents lived. Her Scottish/American Indian grandmother was a tremendous influence in her life, she says, and spending time in rural California with extended family and tribal people gave her valuable insight into the issues affecting ethnic groups outside large cities.

"I remember her as a lovely young lady; very, very bright--and recognizably so at a young age," says David Haskins, MD, Wyllie's childhood pediatrician. "When she was able to go to medical school, her parents wanted her to stay on the Pacific coast. And at that time the medical school at the University of Washington was the best one on the Pacific coast. I happened to know some of the faculty members that had been acquired from the University of Chicago, so I recommended it and she went there."

She put herself through college, and while that can be a great struggle, it builds character, she says. "It's really been invaluable in life because it truly gave me a different perspective on, and appreciation for, earning your own way," Wyllie says.

"My parents and family had faith in me and believed that I could accomplish whatever I set my mind to, in my own way, as long as I applied myself Even though it might be hard work, I could do it. My grandmother was a very strong woman. My Mom has been a foundation in my life -- a strong woman with a positive attitude towards life. And my Dad, an advisor to me."

Those role models would serve her well in college in the 1970s and later in medical school. There were few women in her science classes at the University of California and still much ground to be broken. It was at UC-Berkeley that she took her first classes in public health.

"It [public health] just resonated with my spirit. I thought, 'This is it; this is where my niche is.' I wanted to make a difference in people's lives on a personal level, and later as I've grown in my profession and my skills, every position I've had has laid another layer over my foundation and enhanced my breadth of experience.

"Probably a true family practitioner is how I'd describe myself. I like variety in every way, academically, clinically, and I get lots of it in my current position."

Pediatrician's influence

Wyllie moved to Ann Arbor, Mich., to earn her master's degree in public health in 1985 from the University of Michigan. Wyllie did her internship at the University of Rochester Medical Center in New York, starting out in obstetrics and gynecology but later changing to family practice.

When she returned to the west coast for her residency in family medicine at University of California at San Francisco, she got the chance to work alongside her childhood pediatrician, Haskins, who had become chief of staff for St. Luke's hospital.

She then spent two years in the southwest as a family physician and deputy clinical director on a multidisciplinary team on the Tohono O'Odham Indian Reservation in Sells, Arizona. Part of her duties included emergency and trauma care.

"It felt like a residency at times because of the workload and long hours," Wyllie recalls. "Everybody was in it together. It was akin to a M.A.S.H. unit; we had the helicopters coming in and we were there to make it work. People were dedicated and committed. We had amazing folks that were bitten by the public health bug and were very committed."

Wyllie chose to work with American Indians because her heritage and her experiences as a youth nurtured an interest in serving diverse populations. Among her medical school experiences was a turn at the Alaska Native Medical center in Anchorage, spending six weeks doing psychiatry and therapy--in the dead of winter.

"That's where I learned what true cabin fever was," she jokes. "It was wonderful. I visited in Ketchikan, Alaska, last year and I'd go back to Alaska in a heartbeat. I loved it; I didn't mind the cold, either."

'Dr. Dawn'

Winter in Alaska is good training for winter in Bemidji, Minn. The name "Bemidji" comes from the Ojibwe "bay-may-ji-ga-maug," which means "a lake with crossing waters." It's a place where two-lane roads connect the small towns, passing through thick pine forests and flat, bleak prairie. Think "Fargo," the movie, and you've got the idea.

Despite a full schedule, Wyllie-- known as "Dr. Dawn" to her youngest patients--practices about one day a month doing urgent care medicine at Cass Lake Indian Hospital on the Leech Lake Indian Reservation in northern Minnesota. She also visits her ancestral reservation in Sisseton, South Dakota, where she focuses on providing women's health care.

Among the main health concerns of American Indian populations is diabetes, which is statistically much higher among American Indians and being diagnosed increasingly in young people. Cancer and heart disease are also on the rise in Indian communities and the infant mortality rate in Minnesota is particularly high.

Wyllie's areas of special expertise include addiction medicine, women's health care and wellness education.

"She has provided great leadership for a variety of health issues affecting Indian people," says Craig Vanderwagen, chief medical officer at the Indian Health Service in Washington, D.C., and chief professional officer for the U.S. Public Health Service commission's corps.

"She has been a champion of the health needs of Indian women, and she has also been a very strong leader in the area of family violence and other dysfunctional behaviors at the family and community level -- particularly in regards to women and children.

"She has also, I think, demonstrated pretty strong leadership in the notion of linking clinical medicine and public health. That is, some doctors are pretty much engaged in medical service delivery. Dawn has always been pretty adept at identifying and working with the public health issues as they play out in terms of the impact on individual patient health, family health and community health.

"That kind of leadership, which looks at not just the immediate clinical issues but looks at how can we change the environment to make it a more well environment, is exceptional," Vanderwagen adds.

What drives Wyllie, first and foremost, is the patient. She admits she has had a hard time letting go of clinical practice to handle her administrative duties.

"It keeps me grounded as a person and connected to my community as a physician and what's really going on in the field. I can be a better advocate for change and for the health care resources that need to come to our communities so we can provide the services that are so desperately needed," she says.

"Besides, I really enjoy patient care and like clinical medicine as well as really enjoying the executive/management/leadership/administrative things that I do. And I have talents in those areas. I'm applying those skills learned in my career and taking them from the individual patient into the broader community in a wider context with a greater impact."

Indian culture

In her role as a manager, gratification comes in the day-to-day relationships that her office forges as well as the opportunity to influence policy and effect change on a broader level, she says. She advocates for public health and Indian health care at all levels and at every opportunity.

"We have an opportunity in our roles to be educators and be strong advocates for the population that we serve, providing day-to-day direction within the area office but also as consultants to the tribes," Wyllie says.

"I do a lot of medical consulting, help coordinate preventive health initiatives, work through concerns with the tribes to meet their needs--whether it's clinical or professional staff issues. I'm also a liaison with state agencies and other federal agencies and a principal advisor on public health matters that arise, such as disease outbreaks on reservations."

Wyllie says getting things done on behalf of Indian communities means not accepting the conventional solution to a problem or taking "no" for an answer.

"I look for creative ways to get something done because it's the right thing to do," she says. "Obstacles are just challenges to me. We do live in a very bureaucratic system, but there are ways to accomplish things that are important. Sometimes there are impediments, but you need to take a risk, and maybe you'll get a little heat for that, but in the long run it's that risk that ends up changing the policy."

Listening, she says, is very important; understanding the Indian culture is crucial. Each tribe is a sovereign nation, so when Wyllie's agency works with tribal councils, it's critical to be open-minded and respectful of traditional beliefs.

"In the native culture, you can't separate out spirituality from the person. The wellness comes from a balance between mind, body, emotions and our spirit or soul," she says.

"While we're trained in contemporary medicine, it's important to have a respect for traditional values and culture and ways. And while I don't practice those per se, I value and embrace them, because I believe it's critical to a person's healing."

Intuition and risks

Wyllie is the single parent of a school-age son, and like most women, one of her biggest challenges is balancing work and family. But she adds that she wouldn't change a thing about her life.

What's her advice for other women interested in medical management? Follow your intuition and your passion, and be willing to take risks.

Wyllie says she is having so much fun doing what she's doing that she doesn't want to make any changes yet. But international traveling is among the many interests she'd like to pursue in the future. When she served as a delegate and plenary speaker at the 1998 "Healing Our Spirits Worldwide" conference of the World Health Organization in New Zealand, the experience whetted her appetite for serving indigenous people globally. Her fantasy would be to continue her work on a global level-perhaps in her retirement years.

Work during retirement? Wyllie doesn't consider what she does "work."

"There's work, there's a job, there's career and then there are things you enjoy doing in life. I don't view it as work so much as what I'm interested in. If I am blessed to do all the things, or at least part of the things I'm interested in the rest of my life, I'll be a very fulfilled person."

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Name: Dawn Wyllie, MD, MPH

Age: 46

Current Deputy positions: Area Director/Chief Medical Officer, Bemidji Area Indian Health Service, Bemidji, Minn.

Prior: Medical Director, Chapa-De Indian Health Program, Auburn, Calif.

Education: University of Washington, Seattle (MD, 1985); University of Michigan, Ann Arbor, Mich. (1985, master's in public health); University of California, Berkeley, Calif. (1978, bachelor of science).

Free time: Enjoys travel, spending time with her son, outdoor activities, music.

Workday: About 10 hours-but sometimes with plenty of take-home work

View On wellness: "Wellness comes from a balance between mind, body, emotions and our spirit or soul."

Susan M. Barbieri is a freelance magazine writer and editor in St. Paul, Minn.