Kika Kaui had options and time at the outset of 2020.

A medical student finishing her first year in the University of Washingtons Washington, Wyoming, Alaska, Montana and Idaho medical school program , Kaui knew she wanted to learn medicine as a way to serve at-risk populations. She planned to do a rotation through the schools Rural Underserved Opportunities Program, a monthlong clinical immersion in a rural or urban underserved setting.

Then, in the middle of spring break, as the global pandemic set in, in-person classes were canceled for the rest of the quarter and her hopes for getting into a clinical setting for the first time this summer seemed far less likely.

Luckily for Kaui, she had met Toni Lodge, the CEO of the NATIVE Project, at a powwow before the pandemic hit. When an opportunity opened to do her RUOP rotation at the NATIVE Project this July, Kaui accepted. She was able to shadow John McCarthy, a UW professor and doctor, at the clinic and gain valuable time helping patients.

Kaui, who is Native Hawaiian, has a background in human rights and social studies, and was a Peace Corps member in Morocco before returning to college to take pre-requisite courses for medical school.

Part of the RUOP program requires students to do a research project, and Kaui decided to study diabetes and treatment for vulnerable populations. Her research this summer focused on diabetes care for patients experiencing homelessness and the challenges that come with food insecurity, difficulty accessing or storing insulin, and getting care.

The NATIVE Project was an ideal place for Kaui to learn about integrated medicine. The clinic has mental health and substance use disorder services and also offers full medical and dental care to its patients. It is a federally qualified health center as well as a Title V Indian Health Services clinic.

One of the big differences between the NATIVE Project clinic and most other health care settings, Lodge says, is the practice of generational medicine.

So we will know patients from the time they are little to the time they are elders, Lodge said. You have to have a different relationship. Our clinic director calls it being bonded and attached.

This spring, the tight-knit clinic also became ground zero for COVID-19 in Spokane County, testing for and confirming the first positive case of the virus in March.

Our staff did everything right. We were ready on that day, Lodge said.

Since then, while some staff members have contracted the virus, none have contracted it at work, McCarthy said.

Kaui spent her monthlong RUOP experience at the NATIVE Project in July, as a new norm was taking shape at the clinic. The NATIVE Project can only see about half as many patients as normal, meaning Kaui was using FaceTime or phone calls to communicate initially with some patients. This was new, not just for Kaui but also for the patients.

I have heard patients say, I was nervous to have a Skype or Zoom meeting, and I really appreciate that this is the first time they are on Zoom, and they are willing to do it for their health, Kaui said.

In the clinic, if one of McCarthys patients is willing to let her shadow the visit, she did. Once personal protective equipment was secured and no longer a pressing concern, McCarthy wanted students back in patients rooms.

Its a double-edged sword. You dont want to use up your sparse PPE on people that dont need to be there, McCarthy said of the university. But once we got that world under control, I think absolutely we need to bring back learners into this situation, because you cant be a good clinician if youre not seeing patients.

Lodge said PPE has been a challenge, especially at the outset of the pandemic. The clinic did not receive N95 respirators until 100 days into the pandemic, and providers there are still using expired PPE they received from the federal government.

Masks can make connecting with patients difficult, and with the current anxiety and stress levels generally higher due to the pandemic, it isnt uncommon for patients to express concerns about their mental health.

I think the fear and anxiety around people are probably making them sick, literally, Lodge said. Were seeing people with medical issues that are exacerbated with the pandemic.

When Kaui worked with a patient who had a medical need and expressed needs for behavioral or mental health services, she was able to make a referral in the same building and in real time, as the NATIVE Project has therapists and behavioral health professionals on staff.

Kaui finished her clinical time at the NATIVE Project at the end of July and will complete her research on diabetes in the coming weeks. She wont be in a clinical setting again until next summer, and she is grateful for her experience.

Becoming a doctor, for Kaui, is a way to help women and underserved communities.

Its a good mix of medicine and social justice, she said.

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'Its a good mix of medicine and social justice': Medical student gets experience at NATIVE Project during pandemic - The Spokesman-Review