Ready Responder Finds Fulfillment in an Emerging Island Nation

For Lieutenant Commander Paul Heiderscheidt, M.D., working as part of a mission-driven team building the health service infrastructure of the Republic of Palau–a former U.S. territory in the south Pacific independent since 1994–is a dream come true and realization of his career goal to improve the health of those most in need.

Heiderscheidt's journey to the Pacific region started during his residency when an opportunity arose to teach community medicine in Micronesia at a grant-funded, American-style medical school directed by Dr. Gregory Dever. The two worked together in Micronesia until the end of his residency, after which Heiderscheidt spent the next 5 years working with underserved people in the U.S. via teaching and practicing family medicine.

During this time, Dever became the director of hospital and clinical services in Palau at the emerging island nation's only hospital, as well as the executive director for a newly formed post-residency program. Because Heiderscheidt viewed Dever as an important and inspiring mentor, he jumped at the opportunity to once again work with Dever in Palau when a position opened up. What's more, this opportunity afforded Heiderscheidt the chance to become an NHSC Loan Repayor–a blessing due to the amount of debt he racked up in medical school. He had already applied to the NHSC once–as a first-year medical student–but was not awarded a scholarship.

"I toyed with the idea of joining the NHSC from day one," said Heiderscheidt. "But because my thoughts about what I ultimately wanted to do were still unfocused when I first applied for an NHSC Scholarship, I was not selected."

However, because of his commitment to underserved populations and willingness to work in austere environments in developing countries, the second time was a charm for Heiderscheidt. He was chosen as an NHSC Loan Repayor and secured a commission in the United States Public Health Service as a Ready Responder–primary care providers who are also part of a mobile team of health professionals trained to quickly respond to large-scale regional or national medical emergencies. Finally, Heiderscheidt felt things had finally come full circle.

Heiderscheidt acknowledges the challenges that exist in this remote island. "As one might expect, there are many health care gaps in a country as young as Palau," he said. But "the universal health care system here ensures a safety net for its people in terms of covering costs." Even modest co-payments, however, impose financial difficulty on native Palauans, many of whom are involved in subsistence farming and fishing, or are unemployed. As such, the 5 major government-run clinics and numerous remote stations scattered throughout the islands offer a sliding scale and flexible co-pay system. The medical services provided are basic but able to effectively meet most essential health care needs.

In terms of clinical activities, Heiderscheidt describes himself as a roving resource covering the ER and out-patient departments at the main hospital, and filling in gaps at distant clinics. Depending on the location, the clinics treat 10 to 200 patients per day. For the most part, his patients seek medical care for diabetes, heart disease, and obesity–diseases related to poverty, and dramatic changes in lifestyle and diet, over the last 50 years. Because of the presence of a strong public health system and safety net, Palau's childhood immunization rates are 95 percent, and the neonatal mortality rate is virtually nonexistent. However, other indicators, such as overall life expectancy, prevalence of certain non-communicable diseases, and access to care due to geographic isolation-Palau is an archipelago of several hundred volcanic and limestone islands and coral atolls divided into 16 states–place it among the most needy of all NHSC sites. On occasion, Heiderscheidt's job has taken him to remote clinics that are many days away by boat from Palau's only hospital.

Once, Heiderscheidt transported 2 sick children, along with a boatload of seasick people, in open ocean water on the edge of a typhoon. "These folks live in a place where injury and illness are common, and help is far, far away. We were fortunate that we made it to the hospital in one piece. That does not always happen."

Ultimately, according to Heiderscheidt, the success of his or any mission is best measured by the legacy one leaves behind once the mission is complete. "I am fortunate to be working with dedicated people contributing to the creation of new things of value," he said. "What matters most to me is making people's lives better, and direct patient care is the purest form of that kind of work. In the process of providing direct patient care, one comes to recognize that some illnesses or injuries are the result of a broken system more than a broken individual. I consider myself fortunate that I can work to improve health on both the individual and system level."

And bringing about positive change is what Heiderscheidt holds closest to his heart. "It is fulfillment, not money, that makes it all worthwhile."

Learn about other NHSC success stories.