Serving Indian People
Maxon, PharmD, is an enrolled member of the Cheyenne
River Sioux Nation. He grew up on the Standing Rock
Reservation. Maxon has been a pharmacist at Parker
Indian Health Service Hospital in Arizona, since he
received his PharmD from North Dakota State University
in 2003. When the article below was published Maxon
had been worker at Parker for a few years. Now, as you
can read in the UPDATE 2010, following the article,
Maxon is the new Chief Pharmacist at Parker.
At Parker, a facility that primarily serves Hopi, Chemehuevi, Mojave, and Navajo people, Maxon and the other four pharmacists spend most of their time providing outpatient care. “When the patients’ charts are brought to us, we make sure that the appropriate drugs have been prescribed and that the dosage is correct. We check for side effects as well drug interactions. Also, if the patients medications needs monitoring, we make sure there is an appropriate way to do this.”
Maxon enjoys interacting with patients. After providing information to them about their drugs, he often asks them to tell him in their own words about their medications and how they should be used. “That way we can help them if they have any misunderstandings,” he explains.
Parker is one of the growing number of health care facilities that offers pharmacy-based clinics for people with conditions that need to be monitored. “These clinics not only are convenient for patients, but they also provide opportunities for patients to become better educated about their condition and their drug therapies,” says Maxon. “Dr. Lori Evans, [PharmD] started an anticoagulant clinic for people with blood clotting disorders who have already been started on therapy by their physician. If their physician feels their situation is under control and Lori feels they can be accepted into her clinic, then instead of seeing their physician at each visit, they can come directly to the pharmacy to be monitored.
“Typically she first does a simple blood test by a poke of their finger and obtains results within a few minutes. Then based on the blood test results she follows a protocol that helps her with dosage adjustments if required. If patients are progressing well, they can get their refills and whatever else they need and be quickly on their way. If we need to adjust the dosage, we counsel the patients, making sure they understand the change. Regardless of their situation, we’re always ready to answer patients’ questions and give them needed information.”
Most patients come to Parker for the anticoagulant clinic. Dr. Evans, however, sometimes travels to smaller clinics to monitor the care of patients who live in more remote areas.
Once a week, Maxon and his colleagues participate in a diabetes clinic that involves other health professionals at Parker. “When patients arrive, depending on what they need, they see their physician, the eye doctor, the dentist, the foot doctor or others,” says Maxon. “It can take a couple of hours, but in the outside world, patients would have to have separate visits to multiple facilities. The pharmacy is the last place that the patients come. We make sure they know what their meds are called and what they are used for. We make sure they know about important side effects. We always ask them if they have any other questions regarding their meds or their visit to the clinic that day. Basically we try to tie things together.
“At the end of the morning after the clinic, the diabetic team gets together. There is one person from each department – a nurse, podiatrist, dietician, social worker, dentist, optometrist, and physician. We discuss problems that patients or we may have had in the diabetic clinic. For example, maybe the chart didn’t get to someone quickly enough. This is a time to voice complaints and concerns so we can provide better patient care.”
Besides doing outpatient care, Maxon and the other pharmacists share responsibilities for emergency and inpatient care. Every morning begins with one or more pharmacists visiting the emergency department where they check the charts of patients who were seen overnight. Then they input relevant information into the record keeping system. The pharmacists also need to make sure that the emergency department is well stocked with medications and that the use of the medications is monitored and recorded.
About every 5 weeks, Maxon spends one week in the 15-bed inpatient unit. Pharmacists are important members of the health team that includes physicians and other health professions, so at 8am, the pharmacist who is to cover the in-patient service, “rounds” (reviews the status of patients) with the team. As in outpatient care, the pharmacists check for the appropriateness of the medications, side effects and drug interactions “In outpatient care, if we want to make a change in the medications we have to track down the doctor,” says Maxon. “Inpatient care is nice because you are working face-to-face with doctors, so you can address issues right way.”
Recently Maxon attended a continuing education conference for pharmacists. Pharmacists have to work hard to keep abreast of all of the new developments in pharmacy. That’s fine with Maxon. He is glad to be in a profession where he can continue to learn and be of help to others.
From Football to Pharmacy
Being a pharmacist was not Maxon’s goal when he was in high school. “I chose North Dakota State University because it had a good football program. I was young and thought that I was going to play sports the rest of my life. My first couple of years of college were rough. Looking back, I can’t believe that I made it through.”
“My best support was my family,” Maxon continues. “Without your family it’s hard to stay focused and see how all the hard work will benefit you further down the road.” Maxon’s friends who went on to college also supported him.
The Native Americans in Pharmacy Program was yet another source of support for staying in school. He learned that there was a shortage of pharmacists and that the work was rewarding. For three summers he worked at McLaughlin Indian Health Service Clinic on Standing Rock Reservation. The next two summers, he again worked on the Standing Rock Reservation, this time at the Indian Health Service Hospital at Fort Yates. “Working with the pharmacists was a lot of fun,” Maxon remembers. “I worked almost like a pharmacy tech. I’d type the prescription labels, enter information into the computers, and put orders away. I even filled some orders with a pharmacist backing me up. I began to get used to the drug names and strengths.
“When I finished pre-pharmacy and got into the professional program, I thought it was going to be clear sailing. But the classes get harder each year. I think that’s why I slipped up and didn’t make it through my one class the first semester. You have to study every day. It’s grueling, hard, and challenging, but it will make you a very smart professional person.
“My mom and dad both continued to support me. It was kind of hard for my mom in the end though because she was going to school herself. Also she had to go through treatment for breast cancer. I didn’t tell a lot of my professors about that. It was tough the last semester.”
Despite challenges, Maxon’s mother, Carol Gaurreau Maxon, also made it through school, with a degree in elementary education. She is now teaching at McLaughlin Elementary School. She is a role model for her son, who, in turn, is likely to be a role model for others.
This article was originally published in the Autumn 2004 issue of Winds of Change. (The cover artist is Clarrisa Hudson, Tlingit.)
Jeff Maxon writes:
- I am currently the NEW Chief Pharmacist for the Parker Indian Health Service Hospital.
- I am still the manager of the pharmacy-based, anticoagulation clinic.
- We have added both a cholesterol reduction clinic and a tobacco cessation clinic to our pharmacy services.
- We are also implementing a pharmacy-based asthma clinic and vaccine clinic.
- I have also expanded my pharmacy experience by working weekends part-time for a retail pharmacy store in Lake Havasu.
- We have re-implemented our student training programs. Each month we accept two to three students who are in their last year of pharmacy school. We have affiliations with three universities (Mercer University, Campbell University, University of Arizona). We expose the students to the U.S. Public Health Service side of being a pharmacist. We also train them to be providers in our pharmacy anticoagulation and cholesterol clinics. During their rotation with us, the students are also required to give one 30 minute presentation to the medical and pharmacy staff. Six students, who did rotations with us last year, have applied for positions and residencies in the Indian Health Service.
Jeff is still based at Parker Indian Health Service Hospital in Arizona where he was recently promoted to Lieutenant Commander and Deputy Chief. As Deputy Chief he supervises employees and has other administrative responsibilities. Jeff is also manager of the pharmacy anticoagulation clinic. Patients, who have been referred by their physician to this pharmacy operated clinic, are taking the blood thinning medication, coumadin® (warfarin). Jeff, who is certified in the care of these patients, monitors his patients’ blood by a simple finger stick and makes sure they are taking the appropriate dose of coumadin® (warfarin). This kind of direct care of patients is a growing trend in clinical pharmacy.
In addition to his work at IHS, Maxon has had several invitations to speak on healthy living topics. Recently, he appeared on a local television program called “Healthy for Life” where he talked about healthy eating habits and how to prevent obesity. He also talked about his career as a pharmacist.