Summer 2023

Summer 2015

University: LECOM School of Pharmacy, Bradenton, FL
Active Duty Date: Summer 2015
Duty Station: Tse`hootsooi` Medical Center, Fort Defiance, AZ

This summer I was accepted into one the most competitive programs that Public Health Services has to offer for students. The idea of living on the land of Native Americans, learning their culture, and being able to play a role in their treatment was just a dream for me when I discovered the program. I was fortunate to complete a JRCOSTEP summer externship at Indian Hospital in Fort Defiance. I worked hand in hand with many PHS officers as well as with people from the Navajo Nation. I enjoyed the ability of the program to give me many opportunities in different areas of the hospital. I really loved the experience and was involved in projects about asthma education, pediatric clinic set-up, patient case presentation, living conditions and TB management of Navajo natives.

My main focus was on diabetes, asthma, and anticoagulation management. During the program, I spent many hours with one of the officers who was teaching me how to run an anticoagulation clinic. He was very bright and intelligent; he took his time to explain to me the need of the clinic and our role as a pharmacist in anticoagulation. He opened my mind about different opportunities in the Commission Corps. His knowledge and eagerness made me to realize what our profession is and inspired me to become an officer. The pharmacy’s best kept secret became a reality for me and by the end of the externship, I knew that this is something I am really passionate about. I will take all and any opportunities to learn, experience, and become a PHS officer.

I am very thankful to my preceptor Gayle Tuckett who was always responsive to my e-mails. Her patience and eagerness to help showed me that I will be in the right hands. She basically went through the whole process with me and was always there for me. She took her role very serious and made a diverse schedule for me. Every few days I had experienced different clinics with different pharmacists. This gave me an ability to meet almost everyone and to be able to explore different settings. By the end of my externship I knew that ambulatory care is my future field of pharmacy.

Besides all the pharmacy experience, I was very blessed to enjoy the area surrounding by huge red rocks and friendly people. My native friends took me to the hikes that only they knew trails to and introduced me to a delicious mutton sandwich. I enjoyed the amazing views of mountains while driving on Navajo lands. I also was able to visit Lake Powel, Mesa Verde, Antelope Canyon, Walnut Canyon, Sedona, and Telluride that are all in a few hours away.

In conclusion, JRCOSTEP was the most invaluable experience I could wish for. It gave me an ability to directly communicate with PHS officers and ask them anything that interested me. All of them were very pleasant people and was giving me different advises. I really enjoyed every minute of the program and would recommend it to students.

University: University of California, San Francisco
Active Duty Date: Summer 2011
Duty Station: Whiteriver, AZ

After completing my second year of pharmacy school, I set off to Whiteriver, Arizona to experience what will now be known as the best summer I have had in many, many years. I first knew I would love Whiteriver as I drove down the highway to the hospital and passed through miles and miles of beautiful green trees. I could not help but feel both peaceful and exhilarated, which would come to reflect how I would feel for the rest of my stay. From then on, the experience became even better as I started my first day at the hospital.

One of the first things that I realized about the pharmacy department was that the way they practice pharmacy is the way that I want to practice pharmacy in the future. Never have I witnessed evidence-based medicine practiced in a truer sense. To make clinical decisions, the pharmacists do not simply rely on reference tools, but take extra steps to scour available literature and guidelines. I learned how to better analyze primary literature and use them in practice. The level of thought that went into medication therapy decisions was impressive, and my respect for pharmacists has never been higher. In school, I have often wondered whether the information I learned in classes such as microbiology, pharmaceutical chemistry, and physiology will actually be useful compared to rote memorization. Coming here, I realized how important the foundations of science are to my profession.

In addition to being some of the most intelligent pharmacists I have ever met, I also could not help but notice that the pharmacists have a deep appreciation of their community and are continually focusing on improvements that can be made. Often times in other pharmacies, I have seen pharmacists who seem so jaded by their profession that going to their job is more of a means to an end. The opposite is true in Whiteriver. The pharmacists put their hearts and souls into their pharmacy-run clinics and in their patients. But the sense of community also extends beyond the pharmacy and throughout the hospital and the city. It was rare for me to walk down a hallway in the hospital without someone greeting me, even complete strangers. Coming from a big city, I loved the welcoming atmosphere and the collaborative nature of Whiteriver.

One of the best aspects of my JRCOSTEP was that there was no opportunity to be bored. For my first month there, I was situated in the inpatient pharmacy department, and for the next five weeks, I was placed in the outpatient pharmacy department. I was able to work with or shadow the Anticoagulation Clinic, Diabetes Mellitus Clinic, Pain Clinic, Dialysis, Podiatry, Physical Therapy, Emergency Room, and Public Health Nursing, among others. I also was assigned a variety of projects, such as performing a medication utilization evaluation, writing an article for the official newspaper of the White Mountain Apache Tribe, giving a health talk on the local radio station, and writing a drug monograph. During my weekends in Arizona, I was able to explore places such as the Grand Canyon, Sedona, the Petrified Forest, San Diego, and Las Vegas.

I never thought I would learn so much about pharmacy in one summer, and about myself as well. It has truly been a wonderful experience, and I would return to Whiteriver in a heartbeat.

University: University of Arizona, Tucson, AZ
Active Duty Date: Summer 2010
Duty Station: Sells Indian Hospital, Sells, AZ

I served my JrCOSTEP at the Sells Indian Hospital, in Sells, Arizona. Because of Sell�s remote location, the hospital serves as an �all-in-one� medical facility. This afforded me the opportunity to experience many aspects of pharmacy. In the outpatient pharmacy, I counseled patients on their medications and answered various questions they had regarding there medication and care. Through the outpatient process, I also become familiar with the operating system used throughout the Indian Health Service. Through the inpatient pharmacy, I sharpened my clinical skills, participating in chart reviews, rounds with doctors, IV preparations, and much more. I experienced the administrative side of pharmacy as well by participating in meetings and discussions between different pharmacy personnel.

I was also given two special projects to work on. The first was to rearrange the pharmacy inventory. I organized it into appropriate sections, including a formulary and non-formulary section. This allowed the pharmacy to better manage their inventory and identify potential savings. The second project was to enter in over 3,000 patient allergies into a new electronic, unified, database health record. This new database links 4 different hospitals/medical facilities in the Sells unit together and allows health professionals at the various facilities to manage and track a patient�s medical care more completely.

Overall I am grateful for the knowledge and experience I was able to gain through the JrCOSTEP program. I now have a better understanding of what the Indian Health Service is and what their goals are. I am also better prepared to serve as a pharmacist in the future from the experience I have gained.

University: University of Illinois at Chicago
Active Duty Date: Summer 2010
Duty Station: Norton Sound Regional Hospital, Nome, AK

My name is Michael Kenes and I spent 11 weeks at Norton Sound Regional Hospital in Nome, Alaska. I heard about the JRCOSTEP program from Dr. Nicholas Popovich, my advisor at the University of Illinois at Chicago. I was interested from the beginning in the Commissioned Corps and I talked with an older student who had done a JRCOSTEP the year before. After many phone calls and forms, I found myself in Nome, Alaska; a whole world away from home in Chicago.

NSRH is fairly unique in that it is a privately run hospital and serves both Natives and Non-Natives from the whole Seward Peninsula including 15 remote villages. Only an 18 bed hospital, NSRH is fairly small compared to Continental US standards, but its pharmacy can fill around 500 prescriptions per day. Working at the only pharmacy in town, I gained exposure not only to inpatient, outpatient, ER, mail order, and long-term care setting, but also retail. This was especially beneficial for me since this was my first pharmacy working experience. Even though I had only finished one year of pharmacy school, I was able to apply what I had learned to the internship and use the resources available to look up new information.

I spent some time working with the pharmacy-run Coumadin clinic and helped to council patients. I also spent time with the nurses in inpatient to learn more and understand how that area of the hospital is run on a day-to-day basis. During my time at the hospital, I helped the pharmacists switch over software systems. Additionally, I created an inventory system for the hospital's IV stock to allow for easy access, out-dating, and reordering. During the second half of my time in Nome, the pharmacy hired a new technician who was applying to pharmacy school, so I trained him and taught him about classes of medication and other things that would help him in the future.

Most of my time during the day was spent filling prescriptions, managing the inventory of medications throughout the hospital, preparing IV doses, transferring prescriptions, and counseling patients as they picked up their medication. Overall, this was an incredible experience that gave me exposure to almost every area of pharmacy and an opportunity to work with and help a unique patient population. I developed relationships with seemingly everyone at the hospital as well as many wonderful people in Nome, and will miss working with and interacting with them all.

University: Mercer University, GA
Active Duty Date: Summer 2010
Duty Station: Winnebago PHS Hospital, Winnebago, NE

My name is Ashley Khan and I had my JRCOSTEP experience at the IHS Hospital in Winnebago where I worked in the pharmacy. My main roles while I worked there were to not only help in the prescription process from filling to checking to counseling patients but also to work together with the whole healthcare team to provide the best possible care to all of our patients. I got to shadow my preceptor whose specialty is in Infectious Disease. Together we would go see patients that he got called to consult on and he and I would work on what we felt would be the best approach for treatment for each individual patient. I also got to work on some patient education for proper antibiotic use and had my poster on display in the hospital. I helped track laboratory cultures and make sure that each patient was getting the best treatment based on their susceptibility report. I put together an antibiogram for the 2009 fiscal year that tracked both gram positive and gram negative bacteria and their susceptibility to different antibiotics.

I was allowed to help in the IV room. The doctors and physician assistants would call and have us work up medications for their patients or check on dosing or help diagnose patients which allowed me to put to use what I have learned during school. I really enjoyed the anticoagulation clinic which is run by the pharmacy and allows the patients more time and attention because they are seen on a weekly to bi-weekly basis to make sure that they are staying in their INR range and aren�t having any problems with their Coumadin. Overall, I got to see the pharmacists� integral role in the healthcare system in an ambulatory care setting where all the providers work together. I really enjoyed working with the pharmacy team and all the providers learning how to apply what I�ve learned in school to a fast paced environment and getting to see how we are positively impacting each patient.

University: Southern Illinois Edwardsville
Active Duty Date: Summer 2010
Duty Station: Red Lake Hospital, Red Lake, MN

My JRCOSTEP experience took place with the Indian Health Service in Red Lake, MN at the Red Lake Hospital Pharmacy during the summer of 2010. Red Lake Hospital services the Red Lake Band of Chippewa Indians. This was a great cultural and educational experience. Also, being in Minnesota, of course I did a LOT of fishing.

For the cultural side, one of the technicians in the pharmacy (who was native to Red Lake) invited me to attend a powwow. I was very impressed with everyone�s intricate dress, dancing abilities, and the drums. I have never experienced anything like it before. I also attended a Jingle Dress Healing Ceremony, which is said to have first started in Mille Lacs Minnesota. The ceremony had a traditional feast that consisted of walleye, wild rice, corn, berries, and fry bread. The ceremony was remarkable, and very informative about the history of the Jingle Dress and the Chippewa people. There is so much to be learned from the proud and honorable Native Americans.

The pharmacy experience was also second to none. I was able to help counsel patients, help with the anti-coagulation clinic that is ran by the pharmacy, work in the inpatient, outpatient, and emergency room pharmacy, and do many projects for my preceptor. The projects consisted of writing articles for the monthly pharmacy newsletter, a Drug Utilization Evaluation on 3rd generation cephalosporins and vitamin D, and a time study to evaluate the change in work flow that the pharmacy had just implemented. I also attended a conference at the hospital on hereditary angioedema. I will be able to carry much of what I learned over the summer back to school and apply it to my studies.

Everyone I met in the pharmacy and at the hospital was incredible and made me feel right at home. The toughest part about the summer was being away from my wonderful and understanding wife. This experience has solidified in our minds that we both want to pursue a career in the IHS once I graduate.

University: University of Nebraska Medical Center, Omaha, NE
Active Duty Date: Summer 2010
Duty Station: Pine Ridge PHS Hospital, Pine Ridge, SD

My name is Sharla Janssen and I completed my COSTEP at the Pine Ridge Hospital in Pine Ridge, South Dakota. Although I only ended up getting to be there one month instead of three, I had the chance to do a lot of great things. I had the opportunity to work with the Script Pro system, which I had never done before. Not only did I get to work in the outpatient pharmacy, but in the inpatient pharmacy as well which was also a first for me. I feel more confident calculating the doses for and making IVs. Working the window allowed me to interact with the patients and do some counseling. It gave me a great feeling to help an in-need population all while learning more about my profession.

My experience this summer has been wonderful. I enjoyed working with all of the staff at Pine Ridge and learned a lot from all of them. I know that this opportunity will help me when I continue school this fall, as well as in my future career as a pharmacist. I would recommend this site for a COSTEP or rotation to anyone.

University: Drake University, IA
Active Duty Date: Summer 2010
Duty Station: Omak Clinic, Omak, WA

From June 6, 2010 to July 23, 2010 I participated in a JRCOSTEP internship at the IHS clinic in Omak, WA. It�s a small clinic that acts as a satellite clinic to the main clinic in Nespelem, WA, both part of the Colville Service Unit that serves the needs of the Native American population on the Colville Reservation. The Clinic provides Medical, Dental, and Pharmacy Services. I was assigned to assist with normal pharmacy operations (including running the Script Pro automated dispensing machine), counsel patients on medication use, and create a new pharmacy internship manual for usage for future students. This internship provided me with many new opportunities to practicing in a traditional retail setting such as: the opportunity to learn and practice in a federal facility, working in an ambulatory care setting, working more directly with nurses and doctors, and having access to a patient�s complete medical record. Through this internship, I have gained hands-on experience on how IHS pharmacy contributes to the overall health and well-being of the Native American population. I have also learned new techniques for counseling patients on a variety of different medications, a general understanding of how to work within a formulary and how formulary decisions are made, and more experience with giving clinical presentations for other healthcare professionals. This was a great experience for me and I would recommend it for any student looking to work for the Public Health Service, the Indian Health Service or just in an ambulatory care setting.

University: University of Illinois at Chicago
Active Duty Date: Summer 2010
Duty Station: Sault Tribe Health & Human Services, St. Ignace, MI

I worked as a JRCOSTEP in St. Ignace, Michigan this summer. Here, I counseled patients on their medications including showing many patients proper inhaler techniques and proper eye/ear drop administration. I did several smoking cessation counseling sessions which was a great experience for me. At my pharmacy job in Chicago, I counsel on medications all the time, but have never done a complete smoking cessation counseling session. This was a very good opportunity for me to practice counseling and to further my counseling skills.

With my pharmacy being part of a clinic, this gives me the opportunity to collaborate with the physicians to improve patient care. Because of this, I have done research into various disease states that I have yet to learn in school and their treatment plans. I have also had the opportunity to act as the pharmacist checking prescriptions. This helped me practice verifying the accuracy of the filled prescriptions. My preceptor also had me work on learning Microsoft Access and inputting the facility�s formulary into the database.

I have thoroughly enjoyed my time here as a JRCOSTEP. This has been a very good learning experience for me and has helped me grow academically and professionally.

University: University of Minnesota Duluth
Active Duty Date: Summer 2010
Duty Station: White Earth Health Center, Ogema, MN

The staff was so friendly and made me feel very welcome during my time at the clinic. I had the opportunity to counsel patients, observe the pharmacy�s Anticoagulation and Tobacco Cessation Clinics (ACC/TCC) and shadow the clinic�s Innovations in Planned Care (IPC) pharmacist. I was also able to work in the Health Center�s two field clinics, Naytahwaush and Pine Point; shadow one of the reservation�s home health nurses on her house calls; and help the clinic�s nutritionist with Diabetes Bingo.

In addition to pharmacy, my true passion is Complementary and Alternative Medicine. When I found out that I was to do a project during my internship at White Earth, I knew I wanted to learn more about traditional medicine and how it could be incorporated into practice within the clinic. My preceptor, LT Jessica Anderson, did not hesitate to connect me with one of the tribe�s medicine men, Paul.

I was able to interview him as well as participate in Ceremony. One of Paul�s friends, who is a doctor at the clinic, introduced me to a local herbalist, Stephanie, who taught me a bit about plant medicine and the Ojibwe culture. I plan to continue my relationships with Paul and Stephanie beyond my internship.

My time at White Earth as a JRCOSTEP has been incredible. I knew that I would have a great time this summer, but this experience has far exceeded my hopes and expectations. It has truly been life-changing.

I will definitely do another JRCOSTEP internship next summer and I am considering a SRCOSTEP as well. I would recommend this internship to any pharmacy student who would like to see how pharmacy should be practiced.

University: Duquesne University, PA
Active Duty Date: Summer 2010
Duty Station: Klamath Tribal Health Center, Chiloquin, OR

My name is Daniel Spears and I will be a 5th year pharmacy student at Duquesne University. I had an externship through the JrCOSTEP with IHS in Chiloquin, OR at the Klamath Tribal Health from May 17th through July 23rd. My activities included working with pharmacist who filled and checked prescriptions, helped fill prescriptions when needed, along with restocking ScriptPro�, putting drugs away and miscellaneous pharmacy duties. I also assisted in patient counseling, assisted with Diabetes clinic on Tuesday and Thursday mornings, and I worked on a project which composed of gathering, assessing and reporting diabetes related data for clinic diabetes registry patients. Other requirements included working on Task list, research, study and learn various topics assigned by a pharmacist, and complete weekly reports summarizing weekly activities.

I thought the externship was structured very professionally. It maximized my learning through the organization as well as the excellent preceptors at the site. Tim Langford, Dan Conant and Marcus Cox all went out of their way to teach and challenge me in the pharmacy. The experience was invaluable and exceeded my expectations. I would recommend it to anyone who is in pharmacy school and wants to learn.

University: University of Minnesota Duluth
Active Duty Date: Summer 2010
Duty Station: Cass Lake PHS Hospital, Cass Lake, MI

I am working at the Cass Lake Service Unit of the Indian Health Service. My responsibilities while serving as an ensign at this fine facility have been as follows:

• Case studies; review a specific patient record periodically and evaluate for drug therapy problems, present findings to preceptor first, then make suggestions to primary care provider to affect positive outcomes for the patient
• Review, then present medication information to my preceptor as if counseling a patient who is initiating these various therapies
• Fill in at various pharmacy technician duties to include the following:
  • Dispensing prescriptions to patients, occasionally counseling them when prompted by either the pharmacist or by questions from the patient
  • Processing refill requests
  • Preparing prescriptions by either gathering from the robot or hand counting for the pharmacist to verify. When hand counting a control, pulling this control from the Omni Cell, ensuring accuracy of inventory count
  • Answering phone calls from patients occasionally and tending to their requests and questions.
• Helped form a protocol for atypical antipsychotic medications. Specifically, this protocol would allow pharmacists to order pertinent labs for patients beginning and who are chronically on these types of medications.

The summer of 2009 was a season of opportunity for this rising third year pharmacy student at the University of Maryland, School of Pharmacy, as I was asked to complete a JRCOSTEP at Indian Health Service Headquarters in Rockville, MD. Nowhere else in my career have I seen such progress made in advocating for the profession of pharmacy as I have seen done by my supervisors, CAPT James Bresette, CAPT Chris Watson, and CAPT Scott Giberson.

Before I arrived at IHS headquarters, each of these individuals had already been working methodically towards changing the laws that govern our healthcare system, so that all peoples, including Native Americans, could have better access to healthcare facilities and services. All it took was the administration change following the election year that pushed healthcare and hence the IHS�s agenda, into the limelight of DC politics. With Washington insiders taking a renewed interest in both Native American health, and healthcare policy, the IHS became a hotbed of activity upon my arrival.

Immediately after I got to Rockville, I was in charge of collating legislative input from all the different divisions at IHS for a report to Congress. Mark-up sessions were ongoing on Capital Hill, so information-hungry Senate committees and House work groups were always seeking input from IHS and their long running programs utilizing collaborative practice and disease management. Occasionally the COSTEPs would travel with CAPT Giberson to present the information, and what a spectacle that proved to be! When someone�s passion is exceeded only by their knowledge of the subject, as it is in CAPT Giberson�s case, meetings with someone like the Deputy Assistant Secretary of Health go from mundane to meaningful for everyone in the room.

Passion later turned to persuasion during my tour at IHS, as I was tasked with soliciting donors and organizing a blood drive at headquarters. This proved to be easier than expected since the spirit of generosity that exists within IHS is strong, especially when there is such great need in the community for blood supplies during summer months.

In between promoting the blood drive and updating legislative input, I worked on drafting a preceptor agreement to open most IHS facilities up to rotations for pharmacy students. Legal protection for preceptors, as well as site rules and regulations had been missing from previous agreements, so an attempt at a blanket agreement was made to allow all students the opportunity to do a rotation at IHS.

Add to my summer agenda the creation of a staff directory for the office, assisting the Minority Officers Liaison Council with their website and organization, visiting other agencies within Health and Human Services such as the FDA and NIH, and the editing of papers for peerreview and you get a more complete look at what a summer IHS headquarters is like.

All of these experiences came together to create a very memorable summer that was filled with equal parts education and excitement. My eyes are now open to the expanded scope of pharmacy that practitioners within IHS and the Public Health Service enjoy and have been striving to share with other institutions. The IHS and PHS are two agencies that the pharmacy world cannot do without and I would strongly recommend others to come and see for themselves.

My name is ENS Laura Botkins and I am a rising 3rd year pharmacy student at Duquesne University in Pittsburgh, PA. This summer I was placed as a JRCOSTEP through the Public Health Service to be stationed in Eagle Butte, SD on the Cheyenne River Sioux Indian Reservation. I worked under Rick Amundson.

Working with Indian Health Services was a wonderful experience. I joined with the intention of seeing what another culture was like that was further from home. In what was my first hospital experience, I got to see and work with a lot of new things. It was really fun to have a work setting that included both inpatient and outpatient settings. I learned to use the omni-cell and got to input charts, both of which were first time experiences for me.

I was privileged to be able to work on a few projects while at the hospital that I was fortunate enough to present to most of the doctors. I was asked to do a DUE (drug utilization evaluation) on Cipro and how lowering its use could potentially reduce the amount of MRSA and VRE. Through this project, it is the pharmacy�s hope to raise awareness of other preferred antibiotics. I also did research on how to save money by adding and taking away certain drugs from the formularies. This is a very useful skill that I now will have; just by being slightly aware you can learn to save the hospital a lot of money.

What I enjoyed most about this summer was being able to get involved in the community. As an outdoor lover, I was able to go hiking and camping with youth girls from the reservation as a leader on a trip. I also got to help out with a Vacation Bible School in the evenings. I found a lot of joy from living in a different environment.

My experience with the Public Health Service and on the reservation was so good this summer that I am seriously considering joining full time upon my graduation in 2011. For anyone curious about what it would be like to work for Indian Health Services, this would be a valuable, unique experience that would not be forgotten.

My name is ENS Michelle Bryson and I spent 8 weeks in New Mexico at Gallup Indian Medical Center. I heard about the JRCOSTEP program from CDR Foster when he spoke at an APhA meeting last spring. It sparked my curiosity so I completed the preapplication questionnaire on the website. Before I knew it, a recruiter contacted me to tell me more about it, gave me the name of another University of Illinois at Chicago student who had done a JRCOSTEP, and I found myself driving almost 1500 miles across the country just a few months later. Best summer I think I�ve had thus far.

GIMC is a pretty large hospital in the Navajo Nation. The pharmacy fills somewhere around 1300 prescriptions every day. I�d say I counseled about 1200 of these � at least that is what it seemed like! Most of my days were spent handing out prescriptions to patients. I asked the three prime questions that I thought were never used in practice. I had a woman and her husband give me a big hug for being a good listener, and a woman throw a pen at me because she had been waiting all day for her medicine. I saw most of the disease states I had learned about thus far, and got a preview of what I�ll be learning this year.

I spent some time at the pharmacy-run clinics whenever I could, and I got a chance to see patients with CDR Nate Yale, who is one of the few Pharmacy Clinicians in the country. The opportunity to do these types of clinical things while still working in inpatient and the typical filling and dispensing duties all in one job is what I think pharmacy should be like everywhere. In addition to that, it seems that there is a lot of promotion of furthering one�s educations through various programs, which keeps the pharmacists working at these IHS sites not only up-to-date but also satisfied with their work.

Finally, I have to mention that I spent a lot of time exploring the land. As an Illinois girl who never traveled a lot, I had much to see. Every weekend I went somewhere new, and all the places I went were very different from each other. I developed great relationships with all the staff there, and I will miss them a lot. I highly recommend doing a Jr COSTEP to any student who has a very open mind about the job market, and I will definitely be promoting IHS to my fellow students back in Chicago.

University: University of Mississippi, School of Pharmacy
Active Duty Date: 06JUN09 - 27JUL09

Buffalos, babies, and Bricktown are the three terms that best summarize my summer. I was selected as Junior Commissioned Corps Officer for the Indian Health Service (IHS) in El Reno, OK. IHS is one of the several agencies within the United States Public Health Service (USPHS) that employs pharmacists. The USPHS mission �is to protect, promote, and advance the health and safety of our Nation.� I eagerly accepted that responsibility and was presented with numerous opportunities for direct patient care.

My work days in Oklahoma involved a mix of routine pharmacy practices as well as more advanced clinical duties. I filled prescriptions, put up stock, and patient counseled on a daily basis. Counseling patients was the most rewarding aspect of working for IHS. While I had some prior counseling experience it was basic and nothing compared to what I received with IHS. Not only did I learn a plethora of new drug information for myself but I helped educate hundreds of patients in critical need. I really felt like I was living out the USPHS mission.

This was my first time traveling to the western United States and I had a truly enjoyable time. I was exposed to people and places I may never have known before. will never forget seeing my first �real� buffalo and how absolutely huge it was. The clinic I worked for predominately served the Arapaho and Cherokee Indian Nations, and they too, were unfamiliar to me. I had never known a Native American before and was excited and intrigued to learn about their culture. I was most fascinated by their names and language, and loved meeting new people and learning new names.

Not only were the patients wonderful to work with but my coworkers as well. The pharmacist and technician I worked with were encouraging and helpful. They invited all questions I had and always tried to find an answer. As awkward as it may sound it was also great that they were both pregnant. I learned so much about pregnancy, labor, and babies that I will not even have to prepare for my obstetrics and gynecology rotation next year!

University: University of California, San Diego

My name is Yangnae (Justin) Cho and I will be 3rd year pharmacy student from the University of California at San Diego this coming Fall. I did my JRCOSTEP at the Whiteriver Service Unit in Arizona and my preceptor was Brian Campbell.

On a typical day, I spent most of the time counseling patients on their medication. Doing so has taught me a lot about how to communicate with patients and it also taught me what points to emphasize during drug education. In addition to that I had to give a case presentation along with a drug monograph. My preceptor also allowed me to shadow doctors working in the ER and he also allowed me to work both outpatient and inpatient pharmacies.

The biggest highlight of my stay here in Whiteriver was when I got to go on the radio show to talk to the community about Rocky Mountain Spotted Fever. In a way it was a lot like giving a consultation to thousands of patients at the same time without having to deal with patient�s attitude. We also got to pick a song to play on the radio too!

Overall this was a very good experience. I learned a lot more about my profession and it also made me realize that I like to work as a team with other pharmacist to provide patient care and education. It also made me realize that I don�t want to work at retail pharmacy as much. I highly recommend this job to anyone who is looking for a different pharmacy experience.

University: Howard University

USPHS: A Labor of Love

My name is ENS Anissa Ferguson. I am currently a Doctor of Pharmacy Student from Howard University, Class of 2010. This summer I completed a JRCOSTEP experience at the Indian Health Service Headquarters in Rockville, Maryland.

As a result of my JRCOSTEP experience, I have been�

Honored to work under the direct tutelage of preceptors: CAPTs James Bresette, Chris Watson, Scott Giberson and CDR Michael Weahkee. Each have demonstrated unyielding interest and support during my time at IHS/HQE. I have experienced a greater depth in character, professionalism and performance as a result of this experience and the personal guidance I have received from each of them, individually and collectively. Their dedication to the Indian Health Service and the people it serves has been an inspiration!

Thankful for the opportunity to work alongside students from other universities. This intermittent exchange of thoughts and ideas among future pharmacist amidst work assignments has been priceless!

Exposed to the several opportunities for pharmacists available as a member of the United States Commissioned Corp. Demonstrative of such were my various interactions during my tour of duty. Whether in a visit to/tour of/ or meeting at: The Surgeon Generals Office, Human Resources and Services Administration, Bureau Of Prisons, National Institutes of Health, The Pentagon, Capitol Building or the Food and Drug Administration, I was always able to see the strength of the USPHS and its officers.

It was an invaluable experience being a COSTEP. Herein, I was most appreciative of the creative leeway that was afforded to me at the IHS. I was able to create an orientation handbook for new ensigns working at the Indian Health Service in Rockville, MD. Entitled, "The Ensign Escort", this is the accomplishment that I was most pleased to complete. For this reason I considered the service of the men and women of the commissioned Corp a 'Labor of Love', because its definitely a career that requires a lot of you, but if you have a passion for the mission you're accomplishing it will never feel like WORK ....

Peace & Blessings...

University: South Dakota State University

My name is Erica Fleury, and I will be entering my second year in South Dakota State University�s professional program this fall. I spent this summer as a JRCOSTEP in the Pine Ridge Health Care Facility on the Pine Ridge Indian Reservation in South Dakota. While carrying out my tour I was able to meet some great people, learn about technology�s role in pharmacy, and study different disease states. The group of people I worked with was second to none. Not only was my preceptor great, but also each and every pharmacist, student, and tech that I came across. I was able to work with ScriptPro for the first time, and got a better understanding of how important and helpful technology is in the pharmacy. Finally, one of the pharmacists assigned me a disease state each week, and we would then have a conversation about the disease and possible therapeutic options. This was my second tour as a JRCOSTEP, and I will continue to participate in the program for as long as possible. I would strongly recommend this experience, as I give the program credit for the type of pharmacy student I have become. I am excited about my future with the Public Health Service.

University: West Virginia University

My name is Justin McCormick and I am about to enter my third year of pharmacy school at West Virginia University. I applied with the Public Health Service for a position in their JRCOSTEP program, and was offered orders to go to the Indian Health Center in Ft. Thompson SD with the IHS which I happily accepted.

At the health center I worked in the pharmacy filling prescriptions and counseling patients. I was very impressed with the IHS pharmacist�s clinical knowledge and I learned a great deal by discussing the questions physicians would ask the pharmacists regarding medication selection and dosing. The health center was very focused on patient education and I would discuss every new medication a patient was receiving with them, so that they understood why they were taking it and what to expect from it as well as reviewing refills with patients and ensuring I had answered any questions they had about them. I would also sit down with patients who were receiving a glucometer and discuss the ins and outs of the meter with them, proper testing procedure, how to interpret their readings and what to do when they have a high or low number. I also lead a diabetes education class at the health center. I wrote three articles covering high blood pressure and diet, neuropathic pain management, and sleep hygiene for the monthly newsletter viewed by the tribe. I participated in writing a patient satisfaction survey and completed a top 200 drugs worksheet. I also participated in several case management meetings where medical professionals would brainstorm on how best to treat certain patients.

I enjoyed the staff the most. Everyone was very nice and helpful which made this a great experience. The pharmacists and techs I worked with were knowledgeable and facilitated my learning by asking me questions and letting me figure out problems as they arrived.

This was a great experience and I feel very fortunate to have had the opportunity to work and learn at this facility with their great staff. I learned a lot over the summer and I know this experience will help me tremendously in the future. I would definitely recommend others to participate in this program and I am very happy that I did.

My name is Brian McCrate and I am going into my third professional year of pharmacy school at the University of Mississippi. I am originally from Missouri and have an interest in psychiatric pharmacy. After a friend�s advice, I decided to apply for the JRCOSTEP program and subsequently got placed at the Claremore Indian Hospital outside Tulsa, OK. My supervisors were Capt. Sue Arnold and LCDR Mike Lee.

I was very fortunate to be placed at the Claremore Indian Hospital. The facility has both inpatient and outpatient facilities with multiple clinics including anticoagulation, congestive heart failure, lipid, smoking cessation, and hepatitis. While at the hospital, I spent my time divided between the inpatient and outpatient pharmacies. In both, I was given technician responsibilities and helped fill prescriptions. I was also taught how to screen refill prescriptions using Claremore�s electronic health record, complete medication reconciliations, mix IV bags, and counsel patients. I was allowed to sit in on the various pharmacy run clinics. As part of my JRCOSTEP experience I was expected to complete projects. Some of these projects included drug reviews for P&T committee, data collection, chart reviews, article searches, presentations, and retrospective data analysis. Also, I was able to attend anticoagulation training and various hospital meetings.

Claremore Indian Hospital allowed me to gain a broad perspective on healthcare. With the electronic health record, I was able to view patient�s medical history and help make drug interventions that I would be unable to do at other health facilities. I was able to become much more knowledgeable on many disease states and more comfortable with clinical practices. I believe that the Claremore Indian Hospital provided me with an amazing experience that has fueled my drive to become a clinical pharmacist. With a large staff of devoted pharmacists, Claremore provides a very conducive environment for learning and growing professionally. I highly encourage any COSTEP to pursue this site. Also, for people not from Oklahoma, Tulsa is an exciting city with a lot of great places to visit including casinos, riverside path, Oral Robert�s University, wide variety of restaurants, parks, and clubs. Not to mention you are only an hour and half away from Oklahoma City.

My name is ENS Theresa McEvoy. This fall I will begin my third year of pharmacy school at Midwestern University Chicago College of Pharmacy located in Downers Grove, IL. This summer I had the opportunity to participate in the JRCOSTEP program with the Indian Health Services (IHS) division of the Public Health Service (PHS) at the Choctaw Nation Health Systems Authority in beautiful Talihina, OK. I have served under the direction of CDR Don Branham, PharmD Chief Pharmacy Officer.

I have had the opportunity to learn much during the two months spent here about the PHS, specifically the IHS and also the role of the pharmacist in rural health care. The facility offers both inpatient as well as outpatient services and has two separate pharmacies to service both. The facility also offers a pharmacist run Anticoagulation Clinic and Smoking Cessation Clinic. There is a Diabetes Wellness Center as well as various other specialty clinics. I have had the opportunity to spend some time in all of these areas.

My first two weeks I spent in the outpatient pharmacy. I counseled patients using the three prime questions, compiled a list of antidotes on formulary, and prepared a presentation for the Pharmacy and Therapeutics Committee on the uses of Vitamin D which have been indicated with a strong research backing. The next two weeks I spent in the inpatient pharmacy. I was able to help make IVs and stock medications. I helped compile a protocol for a potential pharmacist run hypertension clinic. Also, I was lucky to observe several inpatient surgeries performed.

Next I spent two weeks in the pharmacist run clinics. In the Anticoagulation Clinic I tested patients� INRs and worked with a pharmacist to adjust their warfarin dose accordingly. I also performed an analysis of patients on warfarin who participated in the clinic and compared how often they were in range to patients who were on warfarin and not followed in our clinic. I found more warfarin patients were within range when followed in the pharmacy clinic. In the Smoking Cessation Clinic I performed monthly follow up visits for patients who had recently stopped smoking.

I have enjoyed working in the pharmacy run clinics the most. This has provided me the opportunity to witness pharmacists participating in an active role in patient care. It has also provided me the opportunity to apply concepts I have learned in pharmacy school.

Overall, this was an amazing experience. I was able to learn about the PHS while also furthering my knowledge of pharmacy. I would definitely recommend this program to other students who are interested in the PHS or in learning about less conventional roles for pharmacists.

Hi! My name is Katie Morneau and I am a third year student pharmacist at the University of Maryland, Baltimore. In the summer of 2009, I received the opportunity to participate in a JrCOSTEP in the Public Health Service (PHS) at the Indian Health Service (IHS) Headquarters in Rockville, MD. I worked under the supervision of CAPT Chris Watson, Principal Pharmacy Consultant for the IHS in the Office of Clinical and Preventative Services (OCPS).

During my time there, I was extremely fortunate to work with Rear Admiral (RADM) Robert Pittman, Chief Pharmacy Officer for the Public Health Service, CAPT James Bresette, OCPS Deputy Director, CAPT Scott Giberson, National HIV/AIDS Consultant for IHS, and CAPT Carmen Clelland, Chief, Health Professions Support Branch, Office of Public Health Support.

Over the course of my service, I worked on a variety of projects from publications and political papers, to billing structures and recruitment videos. I had the chance to collaborate with JrCOSTEPs and sites across the nation and with some of pharmacy�s most innovative and influential practitioners. IHS has traditionally been known for leading change within the profession with its innovative practices. I was given the outstanding opportunity to work with many of these leading innovators this summer as they continued to further promote change.

Furthermore, the other JrCOSTEPs in the OCPS and I were encouraged to participate in presentations given by other operational divisions within the PHS and other pharmacy organizations. I was able to gain exposure to the Health Resources and Sciences Administration (HRSA), the Food and Drug Administration (FDA), the Federal Bureau of Prisons (BOP), United States Pharmacopeia (USP), and the American Pharmacists Association (APhA). Likewise, we spoke to the division directors within OCPS to broaden our understanding of all the programs currently going on within the IHS.

Completing a JrCOSTEP is an amazing experience and an outstanding opportunity. I have seen and been a part of affecting change in the profession of pharmacy and have been given opportunities I would have never had anywhere else. Although each individual�s experience will be unique in and of itself, this is an undeniably outstanding experience and one that I would recommend to everyone.

University:Eshelman School of Pharmacy, UNC Chapel Hill

My name is Janine O�Dea. I am a fourth year PharmD student at the Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill. This summer I had an excellent experience working for outpatient pharmacy supervisor Chikanele Onyegam at Fort Defiance Indian Hospital.

As a JRCOSTEP, I worked in a great learning environment from 8am to 5pm Monday through Friday for ten weeks, and was able to take 6.5 paid days off. I counseled patients in the outpatient pharmacy and diabetes education clinic, went on rounds and home visits, and worked in the anticoagulation clinic. In addition, I presented my own drug utilization review to chief staff at the hospital in an effort to improve patient care and save the hospital $400,000 a year. One day I thoroughly enjoyed was helping the medical staff and clients at St. Michael�s Special Ed. Overall, I found the Navajo people to be undemanding and appreciative of my services, which made my work rewarding.

Even though I loved my job, what I did on my time off was the highlight of my experience. I lived in new housing that was a five minute walk from the hospital. On Tuesdays, a welcoming group invited everyone to go bowling, on Wednesdays hiking and on Fridays to have drinks in the driveway. On the weekend, I went horse back riding through Canyon De Chelly, boating on Lake Powell, and mountain biking in Durango. In addition, I toured the ruins of Sky City and Mesa Verde, rode the Tramway, and hiked through the Painted Desert and the Petrified Forest and the Grand Canyon. On the Fourth of July, I enjoyed the powwow, rodeo, Emerson Drive concert, and fireworks at the fair in Window Rock only seven miles away. There are so many national parks and trails nearby that if you are an outdoors person you would never get bored here.

I would recommend this site to any pharmacy student that is considering a career with the Indian Health Services. Besides getting a feel of what it is like to work at Fort Defiance, one can scope out numerous other IHS facilities in the area, including Shiprock, Gallup, Crownpoint, Chinle, Santa Fe and Albuquerque. This summer experience has reinforced to me that it would be great to complete a residency through IHS and then work 20 years for the USPHS. My only question is where, since there are so many great opportunities to choose from. Fort Defiance is definitely on my list of top five places to live and work.

My name is ENS Janet Shaw and I am preparing to enter my 3rd professional year at the University of Maryland, School of Pharmacy. I was fortunate enough to have had the chance to complete a tour of active duty as a JRCOSTEP for three months this summer at the IHS Headquarters in Rockville, MD and see a side of IHS that many never experience. Being stationed at HQ allowed me to work closely with numerous program leaders, including several pharmacists, such as CAPT Chris Watson (IHS Principal Pharmacy Consultant), CAPT Scott Giberson (IHS National HIV Principal Consultant), CAPT James Bresette (Deputy Director, Office of Clinical and Preventive Services), and RADM Robert Pittman (PHS Chief Pharmacy Officer).

Since I was at Headquarters, and not at a clinical site, my assignments were primarily administrative or policy oriented. Although this was not exactly how I pictured an IHS internship, I was delighted to be able to work on many interesting projects, including assisting in the marketing of Pharmacy Task Force accomplishments and ideas for increasing clinical pharmacy practice within the IHS to key policymakers (including the new IHS Director, Dr. Roubideaux); helping with the promotion of a Report of Advanced Pharmacy Practice to the U.S. Surgeon General, the Deputy Assistant Secretary for Health, APhA, and others; and creating job satisfaction and improvement surveys and an exit interview for pharmacy employees nationwide. Perhaps the most exciting thing I did though was assist RADM Robert Pittman in researching and writing the PHS Pharmacy chapter for a book to be published by APhA next spring on the roles of Pharmacists in Public Health � an assignment for which he was generous enough to credit me as a co-author!

In addition to the interesting and varied tasks that I performed at HQ, I was also able to attend meetings of the PharmPAC and at other OPDIVs within the PHS to get a sense of what pharmacists within several other agencies do. In July, ENS Katie Morneau (another COSTEP at IHS HQ) and I got to experience a small taste of PHS clinical activity when we visited the BOP Federal Medical Center (FMC) in Butner, NC and were shown around by CAPT Mike Long. During our visit, we were also able to attend a promotion ceremony, which gave me something to look forward to for myself!

In all, I would not have traded or changed my experience for anything. In fact, one of the most striking things about the Corps is that every officer I have met, regardless of their category, has been extremely enthusiastic about their job, and many have told me that they would join all over again if given the chance. This encouragement, coupled with my time at the IHS this summer, has convinced me that I would like to become a PHS officer after graduation. I would highly recommend applying for a JRCOSTEP to any pharmacy student interested in working to the full extent of the training we receive in school and with a desire to have a satisfying, diverse career in pharmacy.

University: Southwestern Oklahoma State University College of Pharmacy

My name is Sam Shell. I attend the Southwestern Oklahoma State University College of Pharmacy in Weatherford, OK. I will graduate from pharmacy school in May of 2010. My JRCOSTEP tour was at the Clinton, OK IHS clinic pharmacy for 7 weeks (ending July 17, 2009) and my supervisor was Patricia Rodgers. The staff at my location included 5 full time pharmacists, 2 relief pharmacists, 2 full time pharmacy technicians, and 2 summer pharmacy interns (including myself).

We had a Parata prescription robot at our location. My duties included keeping the robot running and transferring medicine from the machine to the pharmacists to check. I also filled any prescriptions that could not be filled by the machine. Counseling patients was my other main duty. Filling prescriptions and counseling patients occupied most of my time (in about equal parts). A smaller amount of my time was spent ordering and stocking medicines and attending meetings on Wednesday afternoons.

I really enjoyed using the electronic health records to find patient information. This helped tremendously before, during and after counseling patients. Our pharmacy rarely makes IV's, but I did get the opportunity to make 2 IV's in our pharmacies' IV room. This is something I thouroughly enjoyed in school and would like to do more of.

This COSTEP tour was an excellent experience for me. I have never worked in any pharmacy before, however all of the employees were very caring and helpful in guiding me without getting upset or short tempered-- no matter how busy we were. The most exciting thing I learned was just seeing the way medicines are used in the real world, alot of which cannot be learned in school. I was looking at the USPHS as a career due to the influence of a couple of friends who work for them. After this COSTEP tour, I affirmed and strenghthened my decision.

I would recommend this internship because it is a unique situation in the pharmacy world. The clinic pharmacy is alot different than a retail or hospital pharmacy setting. Both patient counseling and the co-workers I worked with made this a rewarding experience.

University: University of Minnesota-Duluth College of Pharmacy

Greetings! My name is Reid Smith. I am a member of the Class of 2011 at the University of Minnesota-Duluth College of Pharmacy. I was given the opportunity to work for the Indian Health Service at the White Earth Health Center on the White Earth Reservation in northern Minnesota under the guidance of my preceptor, CAPT Sam Foster.

My eleven weeks at the pharmacy was a wonderful educational opportunity as I was able to participate in many activities at the clinic. I was able to work on several projects in addition to the general day-to-day duties of filling prescriptions, answering the telephone, and patient counseling. If any new opportunity came my way I was always able to take part. Having the opportunity to shadow the clinical pharmacist for a day, spend the afternoon in the Tobacco Cessation and Anti-Coagulation Clinics, and attend P&T Committee meetings gave me great insight into the progressive nature that the Indian Health Service pharmacies are known for.

A highlight of my experience was the presentation I gave to the P & T Committee regarding new research on a proposed drug-drug interaction. It was rewarding to see the physicians specifically mention the interaction in some of the patients� notes. Another highlight was helping with Diabetes Bingo at a neighboring town and attending the tribe�s Emergency Response Team meeting, where we discussed the tribe�s preparedness for a potential novel H1N1 influenza outbreak. I thoroughly enjoyed getting to know the pharmacy and clinic staff who took time to teach me tidbits from their various areas of expertise.

My time at the White Earth Health Clinic taught me the importance of increasing the availability of healthcare in underserved areas. While I am still unsure of the career path I will take after receiving my degree, this summer�s experience helped me realize that working to ensure quality healthcare for all people will be an important part of my life as a pharmacist.

My JRCOSTEP experience was extremely rewarding. The White Earth Health Center is an excellent example of a pharmacy that is trying to expand its role within the health care community. The internship afforded me the opportunity to get a glimpse into the Indian Health Service and United States Public Health Service. I would recommend this JRCOSTEP internship to others.

University: University of New Mexico Health Sciences Center

Hello! My name is ENS Adriane N. Irwin and I am a third year student pharmacist at the University of New Mexico Health Sciences Center in Albuquerque, NM. During the summer of 2008, I had the pleasure to serve the Indian Health Service (IHS) through the JRCOSTEP program offered by the United States Public Health Service (USPHS). I worked for the IHS Division of Health Professions Support (DHPS) at their headquarters office in Rockville, Maryland under the supervision of Rear Admiral (RADM) Robert E. Pittman, Director of DHPS and Chief Pharmacy Officer for the Public Health Service.

During my JRCOSTEP Experience, I had the opportunity to work on a variety of programs managed by DHPS including scholarship, loan repayment, and recruitment and retention. One of the major projects I was tasked with was reviewing the existing literature to discover new methods of recruitment and retention. This project provided a great foundation to understand how the different programs managed by DHPS interrelated and help to accomplish the IHS mission. In addition to this project, I also had the opportunity to evaluate scholarship applications, explore the leadership training opportunities available to USPHS employees, and assist in writing the DHPS updates to the Indians into Medicine and Indians into Psychology Programs.

One of the highlights to my JRCOSTEP experience was attending the IHS Office of Public Health Support�s annual retreat. The retreat brought all three divisions in OPHS together to discuss their role in supporting the mission of IHS. The day was filled with variety teambuilding exercises and presentations on the history of IHS, Native American culture, and number of other topics. The day was a wonderful experience because it provided exposure to the variety of opportunities existing within IHS.

A second highlight of my experience was attending the Uniformed Services University of the Health Sciences (USUHS) Operation Bushmaster and Operation Kerkesner. These operations are practical final examinations for medical and nursing students at USUHS to test their ability to provide care during adverse environments and situations. During our visit, we viewed a training session, toured the operations, and talked with members of the USUHS faculty. The experience provided a unique opportunity to be exposed to the challenges of providing patient care outside of a traditional hospital or clinic setting. The picture on the left is from Operation Bushmaster. A USUHS faculty member is explaining scenario occurring in the background.

My experience in the JRCOSTEP program was extremely positive. It provided exposure to opportunities within pharmacy that are completely different from the roles in community, hospital, or clinical practice. It also taught me about the role the USPHS and IHS have taken in advancing the practice of pharmacy in a hands-on environment. I would highly recommend this experience to any student pharmacist.

University: University of Maryland

As a rising third year student at the University of Maryland School of Pharmacy, I couldn�t have asked for a better experience than my time as a JRCOSTEP at Indian Health Service Headquarters in Rockville, MD. I spent two months working with CAPT James Bresette, Deputy Director for the Office of Clinical & Preventive Services, and my primary assignment for the summer was to help develop the foundation for a textbook on pharmacists and their roles and contributions to public health. This entailed doing research, literature reviews, managing author contact information and discussing how the need for public health pharmacists should be an issue at the forefront of our profession. As a PharmD/MPH dual degree student, this was the perfect opportunity to see how I might apply the skills I acquire through both programs. In addition, the research found was utilized to write a paper for a summer course on reimbursing pharmacists in Maryland through a Medicaid Waiver.

Working in headquarters also enabled me to meet and work with other officers who taught me the �ins and outs� of IHS and shared their experiences in the field. This gave me a new perspective on the pharmacy profession and how clinical pharmacists in IHS can utilize the training received in pharmacy school to the fullest extent. In addition to CAPT Bresette, CAPT Chris Watson, Principal Pharmacy Consultant, and CDR Scott Giberson, National HIV/AIDS Principal Consultant, were among these individuals. I worked with CDR Giberson to develop a survey tool to call state Boards of Pharmacy to ask about collaborative practice agreements in their state. I also accessed and reviewed state laws and regulations to compare legislation to the responses given. We also worked with other students to develop a strategic pathway that outlines how pharmacists might one day receive recognition as primary care providers and gain reimbursement for cognitive services. The outcomes from these two projects were then shared with RADM Robert Pittman for input and feedback. I was also able to assist CAPT Watson and CDR Giberson when the GAO conducted an inquiry on IHS pharmacy counseling practices and a �behind-the-counter� drug class. I then attended the meeting with GAO analysts to discuss the IHS-provided results of the inquiry and contributed information on how pharmacy students are evaluated on clinical skills.

Finally, being in the DC area was an ideal location as I was able to take a summer course while having my COSTEP experience. In addition, I was incredibly fortunate to make several �field trips� to other agencies in the area. The first was a visit to the FDA to meet with LT Susan Pellock. There I learned more about the Office of Generic Drugs as LT Pellock went over an Abbreviated New Drug Application and showed us samples of generic devices that the office receives prior to market approval. Next was a trip made to the Ronald Reagan Building, where CAPT Watson introduced me to Mike Hope, Pharmaceutical Advisor to USAID. Mike is a former IHS pharmacist and explained what he does now at USAID involving the Supply Chain Management System. This tied in nicely with a third trip made to see Dr. Kathy Marconi, Director of Strategic Information in the Office of the U.S. Global AIDS Coordinator for the U.S. President�s Emergency Plan for AIDS Relief (PEPFAR). Dr. Marconi explained her work at the office and then also set up meetings with other individuals in PEPFAR. I learned how PEPFAR works downstream from USAID in Supply Chain Management and also learned from other MPH graduates about their international experiences working abroad. Lastly, being in the DC area allowed me to take part in COSTEP activities such as a tour of the capital, a social with other COSTEPS from the FDA and USP, and lunch with RADM Pittman, RADM(ret) Church, and other officers and COSTEPs working in IHS Headquarters.

My time at IHS Headquarters has been nothing short of amazing. I have never had such a well-rounded, diverse and challenging experience, and it has truly changed my perspective of the profession and raised my expectations for myself. This experience has only strengthened my positive view of the Public Health Service as a place to build a fulfilling and rewarding career.

University: Wilkes University
Duty Station: Office of Clinical and Preventative Services

The Indian Health Services (IHS) is an agency within the Department of Health and Human Services that acts as the primary healthcare provider for American Indian and Alaska Natives.  During my time at IHS, I worked hand-in-hand with my preceptor CDR Scott Giberson, the National HIV/AIDS Principal Consultant, at the Office of Clinical and Preventative Services Indian Health Service Headquarters in Rockville, MD.  As the Principal Consultant, CDR Giberson directs the IHS HIV/AIDS Program and acts as the liaison to external bodies such as HRSA, CDC and Native health organizations.  He also manages HIV advocacy and prevention strategies and evaluates care to American Indian and Alaska Natives across the United States. 

During my rotation, I attended various meetings regarding National Native HIV/AIDS Awareness Day (March 20^th), drafted a national press statement about HIV that will appear on the IHS HIV internet website, edited and released HIV fact sheets for the IHS, authored an article on antiretrovirals, researched and analyzed IHS public health/ quality of care data, and worked as the liaison for IHS to HHS National HIV Mobilization Committee. I also spent time with the Pharmacy Professional Advisory Committee (PharmPAC) in the Surgeon General�s conference room and spent a day at the United States Pharmacopeia (USP). At the USP, I learned about patient safety, monographs and reference standards, drug information, international technical alliance programs, and the organization�s governance and mission.  I toured the Pentagon and Capitol and attended a recorded interview (podcast) with CDR Giberson, for Healthbeat, a government health program broadcast on the AIDS.gov website. I also spent some time at the FDA, where I traveled with CDR Susan Pellock, Pharm. D to the Bethesda Naval Hospital, reviewed an �Abbreviated Generic Drug Application� and received an overview of the FDA�s �Medical Device Program� with CDR Matthew Tarosky, Pharm. D.  

Overall, the rotation was an eye-opening experience that proved how an expanded role of the pharmacist is greatly needed across the United States, not solely to bring about care and service to all patients in need, but also as a public health professional.  Many opportunities are available for pharmacists who may be interested in pursuing a career with the U.S. Public Health Service (PHS). Opportunities available include a career with the FDA, (as a principal investigator, research team member, investigational drug service pharmacist, or FDA reviewer of drugs) serving in the Indian Health Service, (as a clinical pharmacist, chief pharmacist, public health professional, administrator, etc. ) or other positions in any one of multiple agencies that employ PHS pharmacists. My advice is to follow the path that suits you best in pursing your role as a pharmacist, keep an open mind and have a positive attitude. The time has come, now go out there and be leaders in our profession!

University: University of Tennessee, College of Pharmacy
Active Duty Date:
Duty Station: IHS Headquarters

My name is ENS Brent N. Reed and I am preparing to enter my third professional year as a student pharmacist at the University of Tennessee College of Pharmacy in Memphis, TN. During the summer of 2007, I had the opportunity to participate in a JRCOSTEP experience at the Indian Health Service (IHS) Headquarters in Rockville, MD with Rear Admiral (RADM) Robert E. Pittman, Chief Pharmacy Officer for the Public Health Service (PHS) and Principal Pharmacy Consultant for the IHS. I was also fortunate to meet and interact with a number of other key pharmacists in the Office of Clinical and Preventive Services (OCPS) at IHS Headquarters, including CAPT James Bresette, OCPS Deputy Director, and CDR Scott Giberson, National HIV/AIDS Consultant for IHS.

Over the course of my service at IHS Headquarters, I was involved in a number of different projects, demonstrating the dynamic nature of a career in the Public Health Service and IHS in particular. The administrative offices in Rockville help coordinate programs throughout IHS � everything from the provision of clinical services to the development of materials to recruit additional healthcare professionals. As a JRCOSTEP, I participated in several meetings and conferences, helped develop an orientation program for OCPS, and reviewed documents to provide feedback from a student perspective.

One of the highlights of my JRCOSTEP experience was having the opportunity to meet the acting Surgeon General, RADM Kenneth Moritsugu in Washington, DC. RADM Pittman and several other officers representing the Pharmacist Professional Advisory Committee (PharmPAC) discussed a proposal to increase the number of PHS pharmacists receiving training in pharmacy-based immunizations delivery. During the meeting, I was also able to discuss the impact of student pharmacists in increasing immunization rates nationwide through Operation Immunization, a national patient care project coordinated by the American Pharmacists Association Academy of Student Pharmacists (APhA-ASP).

I also attended the Medication Disposal Forum, where representatives from various professional and regulatory organizations discussed the impacts of improperly disposed medications on the environment. During the forum, I had an opportunity to learn more about SMARxT Disposal, a program developed through a partnership between the U.S. Fish & Wildlife Service and the American Pharmacists Association. As a consumer outreach effort, the central theme of SMARxT Disposal is to provide environmentally-friendly alternatives for medication disposal.

During the month of June, I accompanied two representatives from the PHS to the annual meeting of the Pharmacy Manpower Project in Alexandria, VA. Here, we had an opportunity to view the latest data on pharmacist supply and demand, discussing with various member organizations their efforts to address pharmacy workforce issues. I later had the opportunity to present these findings to the PharmPAC at their July meeting.

Throughout my tenure at IHS Headquarters, I assisted several members of OCPS staff in the development of an orientation program for new employees and interns. During my first few weeks at IHS, I recorded notes on various operations and functions within the office and tried to identify missing components that could be included in a revised training workbook for new employees. By the end of my JRCOSTEP, a colleague and I completed the new workbook, as well as directions for developing a live orientation session.

Finally, I had an opportunity to review a number of PHS and IHS materials, including documents used for recruitment and retention. As a student pharmacist, I was able to provide insight on the benefits that graduating health professionals find attractive in potential careers. My involvement in these discussions also allowed me to field questions from my colleagues about careers in PHS. I was also able to review the proposed national HIV/AIDS workplan for the IHS, providing comments and additional feedback on the program and its implementation nationwide.

Overall, my experience as a JRCOSTEP at IHS Headquarters has been very memorable. I would definitely recommend the program to any student pharmacist who is interested in a rewarding and dynamic pharmacy career. It has taught me much about the opportunities available in pharmacy and the role that the PHS plays in improving the nation�s health.

I will be starting my third year of pharmacy school in the fall of 2003. This summer I am working as a JRCOSTEP in El Reno, Oklahoma. This small town is just about 25 miles west of Oklahoma City. I am in pharmacy school in the city, and therefore El Reno�s convenient location did not require me to relocate for the summer. I have always had a passion for the healthcare profession and becoming a pharmacist has been a goal of mine since I started college. Before I went to El Reno, I was concerned about the little amount of pharmacy work experience I had received. I am now pleased to say my learning experience there has left me feeling even more confident and excited about my career in pharmacy.

The El Reno Indian Health Center is a small outpatient clinic with a big heart. It serves over 20,000 patients with only a small number of employees. The clinic serves not only the residents of El Reno, but also those of Oklahoma City and the surrounding areas. Among the employees are pharmacist, April Bryant, and chief pharmacist and my preceptor, Wayne Parrish. Wayne has worked in the El Reno clinic close to 20 years and will be retiring in 2004. I was very fortunate to get to with work and learn under Wayne�s supervision before his retirement. I can assure you he will be greatly missed by his fellow employees and the many patients who have come to know and trust him.

Working as a COSTEP in the Indian Health Service has taught me more than I could ever imagine. Being able to serve such a diverse population and work in close concert with other health care professionals has been not only great learning experience, but also a very rewarding one. I have learned so many pharmacy duties, such as reviewing patients� medical history and counseling patients on their health and medications. I was very excited to finally get to use the knowledge I have obtained in school. I have been able to attend meetings held within the clinic, which has allowed me to get a better idea of the issues pharmacists and other healthcare professionals deal with. Being able to observe and participate in the clinic�s setting has allowed me to see more clearly the pharmacists� role in the Indian Health Service. It has been hard work but definitely worth it. I am looking very forward to finishing school and working as an IHS pharmacist!

University: University of Maryland, School of Pharmacy

My name is ENS Leah M. Hart and I am a second year student of University of Maryland Baltimore Pharmacy School where I am a Phi Delta Chi officer and secretary of Phi Lambda Sigma. My summer is being spent close to home in Rockville at the headquarters for Indian Health Services. Under the direction of CAPT Robert E. Pittman, Principal Pharmacy Consultant and Director, Risk Management, I have begun an exciting and educational experience with the Public Health Service. The first lesson that I learned was that whoever officially salutes you for the first time, you owe them five dollars!

Working here in headquarters is very different from working in the field in that most of what I do during the summer is administrative or research oriented. My first duty as a COSTEP was to research and help to write a paper with some psychologists here about misdiagnosis of ADHD, during which I not only learned a lot, but got to work with great people. My second duty so far has been to co-edit the COSTEP Capsule which has helped me learn much more about what other COSTEPs in the field are doing and has given me the opportunity of interacting with other pharmacy students also participating in the COSTEP experience.

Working here in headquarters has also allowed me to go to various meetings, like the FDA hearing: Evaluating Drug Names for Similarities: Methods and Approaches, where we heard testimonials from various groups associated with the pharmaceutical industry regarding the naming practices of medications.

My preceptor, CAPT Robert Pittman, has played a very large role in making this experience very captivating and educational. As the Principal Pharmacy Consultant and the Director of Risk Management here at the Indian Health Service, he is responsible for providing advice and consultation to IHS, Tribal and Urban component pharmacies as well as many other tasks including policy development issues related to the IHS Scholarship and Loan Repayment Programs and recruitment of pharmacists for IHS. However, he always finds the time to make himself available as a pertinent resource and mentor to myself and the other pharmacy COSTEPS on duty.

My first month as a JRCOSTEP has been very memorable, interesting and educational and I look forward to the rest of my time here.

University:
Active Duty Date:
Duty Station:

I was very fortunate to be stationed at the W.W. Hastings Indian Hospital. The hospital is the largest Indian Health Hospital in the state and employees over 30 pharmacy personal.

During my JRCOSTEP experience my preceptor Travis Watts, Pharm.D, was awarded the Allen J. Brands Clinical Pharmacist of the Year Award and Dick Stowe, Pharm.D, the chief inpatient pharmacist was awarded the Senior Pharmacist of the Year Award for the Indian Health Service. So you can imagine the high expectations for all pharmacists and pharmacy students during their time at W.W. Hastings.

During my first month of duty I primarily worked in the inpatient pharmacy. Working in the inpatient pharmacy has enabled me to perform such duties as patient discharge medication counseling, drug ulization review for appropriateness of therapy in patients with decreased creatinine clearance, antibiotic reviews, inpatient quality assurance and interpreting physician�s orders for appropriateness of therapy. The pharmacy staff has a great working relationship with the other health care professionals. I have been involved with numerous projects and administrative meetings during my internship.

Tahlequah is in the northeast region of Oklahoma. It is located on the Illinois River, which makes for great summer fun. The staff has made me feel very welcomed here and is a very friendly environment for students. I have never hesitated on asking questions because the pharmacists are all very knowledgeable and eager to help in anyway.

It is a privilege and an honor to be associated with such a terrific staff and the valuable lessons I have learned will be with me throughout my professional and personal life.

University: University of Illinois at Chicago, School of Pharmacy

We are two pharmacy students from University of Illinois that came to Rosebud, South Dakota. Here we completed an internship for PHS. Rosebud is home to a hospital facility operated by Indian Health Services. Rick Amundson was our preceptor here at the hospital. It was our first time visiting an Indian Reservation. This was also the first time Rick has had JR COSTEPs to work with.

Because we were the first pharmacy JR COSTEPs to work at the hospital in several years, there were no specified guidelines for us to follow. He decided we should become familiar with the pharmacy before starting pharmacy projects. We rounded with physicians and learned about patient care. One of the projects we completed was to study a patient's chart and present a case study on a typical diabetic patient. The project helped us relate what we learned in class to a real life patient. Some of our other activities included compounding IV's, medication reviews, compounding dermatologicals, and helping counsel patients.

On the weekends we did many fun activities. We visited Mount Rushmore and Crazy Horse, went fishing and horse back riding, and saved a stray dog.

Rick was a great preceptor to work with. He encouraged us to learn about patient therapy by allowing us to follow physicians as well as help counsel patients. We were not restricted to the pharmacy which allowed us opportunities to interact with other health professionals and patients. This gave us an opportunity to see the perspective of the entire health care team. All in all, it was a valuable learning experience that exposed us to a different area of pharmacy than can be found in Chicago.

University: Rutgers, Ernest Mario School of Pharmacy

My name is ENS Nissy Ann Varughese. I am currently entering my third year of pharmacy school. This summer, I had the opportunity to serve as a JRCOSTEP with the Indian Health Service in Zuni, New Mexico. Zuni is located in the southwest part of NM, about 2 hours away from the city of Albuquerque. I spent ten weeks learning about the service and how vital the role of pharmacists are and will become in the future as officers of the United States Public Health Service.

While my time in Zuni, I had the privilege of having CDR John Benson and LCDR Lou Feldman as my preceptors, as well as all the other pharmacists in the unit. My time at the Zuni hospital was spent mainly observing the essential role of the pharmacist in a clinical setting, as well as fulfilling my duties as an intern/technician in the outpatient department. The pharmacy staff in Zuni has a very close relationship with all the other departments. Doctors, nurses, technicians, daily relied on the pharmacists for their expertise. I was very pleased to have had such close interaction with the whole service unit.

During this summer with IHS, I spent a great deal of time counseling patients and I now have a better understanding of how essential it is to address the issues involving drug therapy. Being here, also enabled me to learn about the different disease states that are prevalent in this area, particularly, end stage renal disease. My COSTEP duties also included working on projects such as a pharmacy newsletter and a small segment on the local radio station in which the topic of sunburn prevention was discussed. Being here was truly a tremendous learning opportunity for me.

Aside from working in the pharmacy, my time in Zuni was spent exploring the land, as well as learning about the culture of the Zuni people. I also had a chance to explore the Southwest. I visited the Grand Canyon in AZ, Mesa Verde in CO, and attended the Gallup Inter-tribal ceremonies meeting Indians from all over the nation. It was very exciting to be here for this summer and to have felt part of a friendly and respectful community.

I would like to thank the Zuni Service Unit staff for having me and also the Indian Health Service for giving me the experience of a lifetime by allowing me to be an officer of the USPHS for this summer.

University: Philadelphia College of Pharmacy

My name is ENS Nathan Wible, and I am a pharmacy student entering my second professional year at Philadelphia College of Pharmacy. This summer, I had the exciting opportunity to do a JRCOSTEP with the Indian Health Service in Cloquet, Minnesota. Cloquet is a fairly small town about 20 miles from Duluth, MN and Lake Superior.

Under the auspices of LCDR Scott Giberson, I learned a tremendous amount about the Indian Health Service and the Public Health Service in general, such as: the importance of uniformed service, proper uniform wear, military etiquette, the mission of the PHS, the multiple career opportunities available within both organizations, and the clinical opportunities available within the IHS. I have found that the IHS offers pharmacists an excellent and unique work environment, which enables them to check all prescriptions with the patient's chart, spend as much time as necessary counseling patients, and utilize their clinical education in rewarding ways that traditional retail pharmacists cannot.

Prior to this JRCOSTEP, I had only worked in an inpatient hospital pharmacy; I found the move to an outpatient IHS pharmacy a refreshing change of pace. During my stay, I entered new prescriptions, filled prescriptions, checked blood pressures, and learned and worked on patient counseling skills with real patients. For the patient counseling skills, I learned effective communication skills and the IHS process of asking three main open-ended questions. Additionally I worked on a number of different projects, such as: developing a formulary list of drugs in the pharmacy, grouped according to drug class and disease state, writing pharmacy/health-related articles for the Tribal newsletter, observing and participating in the anticoagulation and hypertension clinics run by pharmacists, learning and practicing immunization technique, getting certified in Basic Life Support, and developing a poster of pharmacy-related issues for pregnant women for display at a pregnancy health fair.

One thing LCDR Giberson frequently stressed was how a commissioned officer can serve on numerous committees, teams, and in organizations in addition to his or her professional responsibilities. He is a good example, since he participates in as many as he can. With his help, I was able to apply for and become the first JRCOSTEP to participate in the Commissioned Corps Readiness Force (CCRF), an all USPHS officer unit that gets deployed and provides assistance in times of extraordinary need or public health emergencies. Since I do not meet all of the requirements to be active, I will not get deployed. However, I am able to work on completing the training modules, which will allow me to be deployable in the future, if I choose the USPHS as my future career.

The JRCOSTEP experience is more than just work; there is plenty of time to enjoy the area around the workplace. I got to live in an entirely different part of the country for the summer and visit scenic spots along the North Shore of Lake Superior while I explored Duluth and other parts of the Northland. Moreover, I had the opportunity to learn about the Indian culture, including watching a traditional Indian pipe ceremony and blessing.

Overall, the entire JRCOSTEP experience has been fantastic. I really enjoy what the USPHS has to offer, and I would recommend that anyone at all interested in the Public Health Service apply for a JRCOSTEP position. If you have any questions, feel free to contact me by e-mail at nwible@yahoo.com.

This summer has definitely been a different experience than any I have ever had before. Fortunately, that is what I expected and hoped for. :)

I moved from the bustling college town of Austin, Texas to a double-wide mobile home in the remote dusty village of Crownpoint, New Mexico, located near the Four Corners area on the eastern edge of the Navajo reservation.

Our facility services Native Americans from both the town of Crownpoint and the surrounding areas, some of whom must drive (or walk) 50 miles or more to receive health care. We offer an inpatient hospital, a 24-hour emergency room, outpatient clinics, both an outpatient and inpatient pharmacy, a mental health center, a physical therapy department, an optometry clinic, a dental facility, and an obstetrics unit.

What a rewarding environment in which to practice pharmacy! On top of caring for the vast array of patients that we see in all of these facets of health care, our pharmacists operate an anticoagulation clinic and an asthma clinic from the outpatient pharmacy. I, as a COSTEP, have been involved in all of these areas of medicine and have found my environment professionally and personally rewarding. Although many of our patients speak nothing but their native Navajo tongue, they have been accepting and patient, and the hospital staff has taught me so much in this short time. I will finish pharmacy school in May 2003, and although I have six rotations left to complete, I know that none of them can provide such a diverse and compassionate work environment.

Who knows? I may end up as an IHS pharmacist after all! :)

University: South Dakota State University

Hello! My name is Jessica Laintz. I am entering my 3rd professional year of pharmacy school at South Dakota State University.

I did a summer COSTEP position in Ft. Yates, North Dakota located in South Central North Dakota on the Standing Rock Indian Reservation. I am excited to share a small amount of what my summer entailed working for the Indian Health Service.

The Standing Rock IHS Hospital is a small 12-bed hospital, providing inpatient, outpatient, emergency, and clinical care. The pharmacy located in the hospital fills about 260 outpatient prescriptions a day.

As a COSTEP I learned and experienced many things. I worked with both inpatients and outpatients. I filled and compounded prescriptions, counseled patients, and made IV solutions when necessary.

I was lucky enough to attend the Pharmacy Practice Training Program in Phoenix, Arizona. After the conference I was able to incorporate skills such as patient assessment and patient interviewing into my regular activities.

I also did a summer-long research project during my stay in Ft. Yates. I did a retrospective chart review to determine the clinic's compliance with American Diabetes Association guidelines in type 2 diabetes patients. I then presented the information to the medical staff with ideas to increase compliance in the diabetic population on the Standing Rock Reservation. This was a very gratifying and educational experience for me.

I was also responsible for entering medication error information into the MedMarx system.

However, my favorite part about being a COSTEP in Ft. Yates was providing drug information to physicians, nurses, and anyone else who needed it. Numerous members of the medical staff would come to me to answer questions about duration of action, dosage, drug interactions, etc. I was very fortunate to be able to utilize my skills in researching and reporting drug information.

I thoroughly enjoyed all of my experiences working for the Indian Health Service as a Junior COSTEP. This is just a small taste of my summer experience. I would recommend the JRCOSTEP position to any student interested in a summer job with variety in a place that will challenge you by utilizing your skills and knowledge base.

THANK YOU to the Indian Public Health Service and the Standing Rock IHS Hospital for the great experience!

University: University of Wisconsin - Madison

I was a JrCOSTEP this past summer at Acoma-Canoncito-Laguna (ACL) Indian Hospital, 55 miles west of Albuquerque, NM. Arriving at ACL was a real culture shock after coming from Wisconsin-very arid, mostly sunburned land, dotted with mesas and mountains. However, I came to enjoy the unique beauty of the Southwest, and most of all, its people. The friendliness of the patients and staff helped me adjust to life on the "high desert."

The ACL Hospital serves the Acoma and Laguna Pueblos, as well as the Canoncito Navajos. The pharmacy performs outpatient and inpatient functions, as well as many clinical roles. Although I was assigned many different duties and projects, I'll highlight just a few.

First off, since ACL has such a high prevalence of diabetic patients, each Tuesday is designated for Diabetes Clinic. I spent time with the optometrist, podiatrist, and dietician to see why their interaction with diabetic patients is so important. Patients also visit physical therapy, the endocrinologist, and pharmacy, to name a few. ACL Pharmacy also works closely with the nephrologist on Renal Clinic days. We perform chart reviews and interview patients about their medications to make sure that they understand what their medications are for and how to take them.

Another clinical role involves patients on warfarin. We interview these patients to assess for efficacy, toxicity, adherence, and interactions. We obtain the INR and adjust or maintain therapy based on the results.

My projects included developing an oral contraceptives protocol, collecting data for a drug utilization evaluation, and presenting continuing education for the hospital staff on "New Hormonal Contraceptive Technologies." I also accompanied a home visit nurse to a few of our elderly patients' homes.

When I wasn't working on projects, I counseled patients on how to use their glucometers. I also jumped in to help the pharmacy staff with their workflow when it became busy.

So many things to do and see in the Southwest! I went to the IHS QUAD conference June 8-9 in Phoenix, along with Paula Svoboda, JrCOSTEP from Zuni Indian Hospital. We hit the Petrified Forest and Painted Desert on the way home. I had a chance to visit the Grand Canyon, Santa Fe, and Bandelier National Park; I got to swim in the beautiful hot springs of Jemez National Forest, tour the Sky City/Old Acoma Pueblo, shop Old Town in Albuquerque, visit traditional Indian feasts and dances, and hike in ancient Chaco Canyon with Wil, Director of our pharmacy. Wil also took my roommate (a dental COSTEP) and I on an 11-mile, 5-hour hike up the Sandia Mountains (awesome view of Albuquerque from the crest!) A James Brown concert at the beautiful Sandia Casino topped off the summer.

The experience wouldn't have been complete without the food: when in New Mexico, you must try the fry bread, Indian Tacos, oven bread, green chile hamburgers, green chile stew, and numerous other delicious dishes made with green chiles!

Being the JrCOSTEP at the Phoenix Indian Medical Center (PIMC) has been a great experience for me this summer. PIMC is one of the larger hospitals within the Indian Health Service that mostly serves the urban Native American population in the Phoenix area. To support this population, PIMC has five pharmacies including three outpatient pharmacies and two inpatient pharmacies. Therefore, I have had the experience of being exposed to many different aspects of pharmacy.

One thing I have really focused on this summer is improving my patient counseling skills. IHS is very proactive in educating their pharmacists to use the �IHS method� to effectively counsel all their patients. At PIMC, I have been able to practice counseling patients with open-ended questions while familiarizing myself with all the different drugs. I have also been able to fill prescriptions and watch the pharmacist screen charts. In addition to learning about the different drugs, I also have gotten to learn about many different disease states. At PIMC, pharmacists see patients in pharmacy-run outpatient clinics. These include asthma, nicotine cessation, and anticoagulation clinics. Through physical assessment and proper patient counseling, pharmacists play a key role in theirs patients health care and well-being.

Whenever I am not working in the pharmacy, my preceptor, LCDR Jennifer Post, keeps me busy making different handouts for patient education or reviewing charts for any adverse drug reactions that needed to be documented. I have also had the opportunity to shadow many different health care professionals within the hospital. Just to name a few, I have shadowed a diabetes educator, surgeon, podiatrist, and a midwife. During these experiences, I was able to see a diabetic foot ulcer, surgery, and a delivery.

It was very interesting to see another aspect of PIMC and how they work with pharmacy to optimize patient care.

My experience at PIMC has been very fulfilling. Not only have I learned about many different aspects of pharmacy, but also other health care professions. Thanks to my preceptor and everyone else within the hospital, I have gained knowledge to continue my education as a future pharmacist.

University: University of Minnesota, College of Pharmacy

APhA-ASP President-elect

This summer, I have the great opportunity to learn a lot about the Public Health Service and serve some committed time in two different settings. Part of my time is spent working in the Indian Health Service Headquarters with CAPT Robert Pittman and another part of my time is spent with the Chief Pharmacy Officer of the Public Health Service, RADM Richard Walling.

The main focus of my time here has been spent learning about the various agencies of the PHS, in particular IHS, and the opportunities for pharmacists in the Commissioned Corps. I have especially focused on IHS programming and the provision of pharmaceutical care to American Indians and Native Alaskans.

I plan on utilizing this knowledge when talking with students around the country through my position as APhA-ASP President-elect and President to answer questions and inform them of their opportunities in the PHS.

Another part of my summer has been spent assisting in the development of recruiting plans for the PHS, reaching out to students to inform them of their opportunities in the PHS.

I also attended the American Association of Colleges of Pharmacy (AACP) Annual Meeting in Kansas City and assisted at the PHS exhibit booth to answer questions and talk with attendees to the meeting about the PHS. In addition to this, I have been working on developing a pharmacy newsletter for commissioned officers in pharmacy that will be distributed via e-mail.

Some additional duties for my position is to help organize activities for the DC area interns and to put together this newsletter. So far this summer, area interns have met once a week for dinner, gone on pharmacy association tours, and have participated in other social activities.

Thus far my JR COSTEP has been very rewarding. I hope that everyone is enjoying their JR COSTEP appointments, and I encourage you to share your experience with us.

To learn more about IHS Pharmacy, go to the IHS pharmacy website at http://www.pharmacy.ihs.gov or call Ed Stein at (602) 364-7745.

*Andrew Traynor is entering his third professional year at the University of Minnesota College of Pharmacy

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University: University of Texas

My internship is located in the Northeast region of Oklahoma, called 'Green Country.' It is well named because the grass is very lush and it rains every week. I am stationed at the Claremore Indian Hospital.

I feel very fortunate to serve under an amazing preceptor. Sue Arnold, R.Ph., was named IHS Senior Pharmacist of the Year in 2000. Sue and the other pharmacists continually ask questions and try to further my understanding of IHS and pharmacy practice. They focus on my interests and help to enhance my understanding of disease management.

During my JR COSTEP assignment, I worked in the anticoagulation and hyperlipidemia clinics. I was also granted the opportunity to conduct a retrospective drug utilization evaluation of metformin. The review involves assessing over 400 patient charts.

My JR COSTEP experience has also enabled me to experience another culture. Claremore is located thirty minutes from Tulsa, which has a variety of art and American Indian museums. I have visited the Foyil Totem Pole Park, home of the world's largest totem pole. During the Fourth of July weekend, I visited Carnegie, Oklahoma, which hosted the annual Kiowa Gourd Clan Ceremonial Dance festival. I have been very fortunate to participate in so many wonderful experiences during my JR COSTEP and 'Green Country Summer.'

University: University of Oklahoma
Active Duty Date: Indian Health Service in Warm Springs, OR.

My experience with the IHS has been outstanding. I have learned how much more the pharmacist is informed and involved in the care of the patients we serve. As we are preparing prescriptions for our patients, we have their chart so that we can understand completely both the current problem and the history of the patient. We know the details of an acute problem and the progression of a chronic one. This changes our entire perspective relative to that of other pharmacy practices. We are able to make informed recommendations to the physcicians about drug selection and dosing. We can also order labs such as LFT's or INR's to properly monitor the patient and make recommendations as to the appropriateness of continuation of the chronic therapy.

There is a comprehensive protocol and standing orders system here as well. It allows pharmacists to prescribe medications for patients with specific disease states such as allergic rhinitis, strep throat, and many others. The pharmacists routinely check blood pressure, and every patient is counseled on every medication - new or refill by a pharmacist or pharmacy student. The pharmacy is much more clinical and there is a significant amount of patient contact here.

Another wonderful thing about being here in Warm Springs is the opportunity to learn about the rich culture of the native people here. They are very open and eager to share that culture. They encourage anyone who is interested to take part in their pow-wow and other activities. Since moving onto the reservation, I have felt welcomed by nearly everyone I have met. I have had the opportunity to attend church services here on the reservation as well. They sing some of the traditional Christian songs that I grew up with in a native tongue, which is special to hear.

I have also had the opportunity to meet several IHS pharmacists. One thing I've noticed about them is that are satisfied with their jobs. After working here, I understand why.

University: Drake University - Des Moines, Iowa

Hello Everyone! My name is Karen Kniker. I was a COSTEP in exotic Wewoka, Oklahoma. I lived in Seminole, Oklahoma and drove to Wewoka for work everyday. (It's only about 20 miles.) The Wewoka Indian Health Services Clinic staffs about 60 employees in primary care, pharmacy, nursing, lab, medical records, optometry, dentistry, community health, and administration. The clinic serves approximately 14,000 active patients. Most of the patients are from the Seminole and/or Creek Tribal Nations. We had a great time in the pharmacy. My co-workers told me I fit in really well with them...I have not yet decided whether or not this is a compliment!

This was unlike any other pharmacy in which I have worked. We got the patient charts and were able to see exactly why the provider was prescribing each medication. This also helped us to detect drug/drug interactions. I loved the patient contact! As many of you know, the Indian Health Services is a pioneer in pharmaceutical care. They were counseling patients way before it became the cool thing to do! Every patient is counseled in a private counseling room before they leave the pharmacy. Whether the patient is getting a new medication or a refill that they have been taking for 20 years, we make sure that they know how to take their medicine and what it will do for them. All of the patients seem very appreciative and thankful for the health care that they receive. Their attitudes made my job even more fun!

I gained experience in a lot more than filling and counseling prescriptions. I got to teach a prenatal class about taking medication while pregnant or breast-feeding. This was very interesting, because while I was teaching, I was also learning from the women in the class. I did a drug utilization review, which I later presented to the providers along with my recommendations on how to get better outcomes from that particular medicine. Talk about feeling important! My next project was to teach a class at the diabetic clinic. There is a very high incidence of diabetes in the Indian population.

I am originally from Kewanee, Illinois, but I go to school at Drake University in Des Moines, Iowa. GO BULLDOGS! In August I started my first year of Pharm.D. classes. Only two more years and I will be a real, live pharmacist! Finally! After school I would like to go on to do some residency training, possibly with the Indian Health Service. I don't know about the rest of you, but I am seriously considering the Public Health Service as a career.

One experience that I especially enjoyed was spending a morning in the Operating Room at an area Indian Health Services Hospital. I was able to scrub in and observe a couple of surgeries. The anesthetics are a whole lot more interesting in a human patient than they are in rats in the lab! Outside "the office" found myself playing a lot of softball. I played on a league team every week up in Oklahoma City.

University: Drake University - Des Moines, Iowa

I am a fourth year student (second year of pharmacy school) at Drake University in Des Moines, Iowa. This summer I had the opportunity to work for the Indian Health Service (IHS) as a commissioned officer in the COSTEP program. My duty station was the IHS Clinical Support Center in Phoenix, Arizona and my preceptor was CAPT Stephan Foster, the Director of the IHS Pharmacy Practice Training Program. His primary role is to provide ACPE approved continuing education for Indian Health Service pharmacists. These training programs help to make IHS pharmacists the best in the field.

This summer provided me with an amazing opportunity. My main function was to assist CAPT Foster by providing support for a variety of the CE conventions and seminars the Clinical Support Center sponsors. One of the programs I had the opportunity to attend was "The IHS Pharmacy Practice Training Program: A Certificate Program in Patient Oriented Practice". This is a certificate program for IHS pharmacists that covers topics on direct patient care, including communication, consultation, interviewing, ambulatory screening, laboratory test interpretation, conflict resolution, and physical assessment of selected disease states. I not only learned a lot about how the Indian Health Service pharmacist functions, but was able to attend the programs to improve my skills as a future pharmacist.

Another of my responsibilities over the summer was to develop a brochure to be used for IHS recruitment. I worked closely with other members of the Clinical Support Center and used previously developed material to design a brochure. The brochure was designed to attract attention to the Indian Health Service and contained information applicable to students, recent graduates, and practicing pharmacists looking for a career change.

I also had the opportunity to work at the Phoenix Indian Medical Center. The IHS utilizes the patient's medical records to fill prescriptions, so not only was I able to work my way through the processing of prescriptions, but I made the connection between disease states, laboratory tests, and the medications. I also got a crash course in how to read doctors' handwriting. I would have to say that the IHS has an amazing system that puts patient care first and utilizes the unique skills of pharmacists as drug experts. I enjoyed this experience because I had never worked in a hospital and feel that everyday I was there, I learned at least ten new things.

Before the summer was completed, I participated in an IV and Total Parenteral Nutrition program that IHS technicians and pharmacists are required to take if they work in the inpatient pharmacy. This has been an amazing summer that challenged me and helped me grow as a future pharmacist. I want to thank the Indian Health service for this opportunity.

Greetings from the beautiful White Mountains of eastern Arizona. My name is Laura Franklin and I am one of the two COSTEPs (the other is Jenny Collura) at the Whiteriver PHS Indian Hospital on the White Mountain Apache Reservation in Whiteriver, Arizona. I speak for both of us when I say that this has been an invaluable experience, both in and out of the office.

We spend our time rotating through the outpatient, inpatient, and Cibecue Health Center pharmacies. Neither one of us had much experience counseling patients before coming here but that changed quickly! The first week we sat in on counseling sessions and learned the techniques (3 prime, open-ended questions and show and tell) and then did some counseling with the pharmacists watching and evaluating our technique. By the second week, we were able to start counseling patients on our own and have been doing so ever since.

We spend one to two days a week out at the Cibecue Health Center Clinic which is also on the reservation, about 60 miles away. The pharmacy there is a little slower paced, which allows time to look up a drug or lab value that may not have been seared into your brain in Pharmacology class! We also have had the opportunity to work in the inpatient pharmacy and gain experience making IV solutions.

For those not familiar with the Indian Health Service, we do all of our dispensing from the patient's medical charts. We review each order for appropriateness in terms of therapy and dosage. Doing chart review gives us (the students) a chance to become familiar with what medications are used most frequently for certain disease states and to learn pediatric dosages.

Our learning experience doesn't just occur in the hospital. We have been able to enjoy the area and the Indian culture that surrounds us here. We have gone to a Sunrise Dance, the ceremonial coming-of-age dance for a young Apache woman. That was amazing to see! We have also been able to travel and see the area including the Grand Canyon, Utah, Las Vegas, Colorado and the list goes on. For people like us who have never been out west before, it has been quite an adventure.

I encourage anyone thinking about doing a COSTEP for the summer to consider doing it with the Indian Health Service - you won't regret your decision.

University: Creighton University - Nebraska

I've heard it a few times since my first day at Creighton University School of Pharmacy and Allied Health Professions "The Indian Health Service is the model for pharmaceutical care." When I heard about the United States Public Health Service's COSTEP, I put two and two together and decided that it was the perfect opportunity to take the bull by its horns and start living our profession's future.

Was it the right decision? Absolutely! This summer, I had the privilege to work at the Fort Hall Not-Tsoo Gah-Nee Health Center near Pocatello, Idaho. The Shoshone-Bannock tribes are primarily recipients of health care at the Health Center. It was different from anything I ever expected. The center has a pharmacy, medical clinic, dental clinic, lab, radiology, community health (for women and child health), medical records office, contract health office, and administration. There is a mixture of commissioned officers and civilian employees.

A true multi-disciplinary approach is fulfilled at the health center. Patients may make appointments or try walk-ins. When the patient is seen by a provider, such as one of our four doctors or physician assistants, the provider records all pertinent information in the patient's chart. The chart is then brought to the pharmacy. Four pharmacists and I staffed the pharmacy. Sometimes we had a clerkship student from Idaho State University. A member of the pharmacy staff reviewed the chart and medications ordered for proper drug choice, dose, interactions, past compliance, and patient history. Then the medications were filled using the computer, the Drug-O-Matic dispensing machines, or whatever is needed. There are times when the provider was contacted to change drug choice, doses, or to discuss the patient's record. After filling the prescription, the patient was brought into a private consultation room for counseling. The ideal "open-ended Prime Questions" and "Show-and Tell" were used with some modifications. I had the opportunity to learn as I leafed through the charts, fill prescriptions, and counseled patients. The pharmacists were always very good at challenging me to learn about therapeutics and counseling on medications or disease states. A very common disease state was diabetes - we had about 380 diabetics. During my COSTEP, I did a compliance study of patients on monotherapy with an oral hypoglycemic using retrospective chart review. The results will be used in an attempt to improve compliance in the next year.

Other opportunities I enjoyed were working with the podiatrist who came on Wednesdays, visiting with the nurse practitioner in Community Health, and visiting patients in their homes with the Public Health Nurse. Before I leaft, I gave an in-service to the nurses. All in all, I've had a well-rounded experience. I found the patients to be much like patients I have encountered when I worked in a private professional building pharmacy - some are great and a few are unhappy. For the most part, the patients respond well to pharmaceutical care. They often ask for one pharmacist by name who "knows my meds." I have found the most rewarding aspect of pharmaceutical care to be the interaction with co-workers. There's a great bunch of people at Fort Hall. If you have a chance, request it by name.

University: University of Illinois at Chicago

My name is Tammy Morro and I spent my summer at the Lawton Indian Hospital in Lawton, Oklahoma. I am originally from Chicago, Illinois and honestly, before this internship I had never been west of the Mississippi River. So, for being a "city-girl" I can say I am adapting pretty well to the Southern way of life. This fall I am entering my third year of pharmacy school at the University of Illinois at Chicago.

Well, my experience as a JR COSTEP was fantastic. We filled all our prescriptions directly from the patients' medical record. This is a bonus because we had the patient's diagnosis and pertinent lab work available right at our finger tips. We also counseled every patient who picked up their medication in a private counseling room, which I thought was especially neat!

My preceptor Stanley K. Work, also kept me very busy working on various projects. I had the opportunity to conduct two Drug Use Evaluation (DUE) studies which were presented at their quarterly P&T committee meeting and I worked with another intern on preparing Ward Stock Lists for the different departments in the hospital. I also attended numerous Continuing Medical Education meetings, and was able to shadow many of the doctors at the hospital.

On July 1, the pharmacy started a Lipid Clinic. It was interesting to be involved with the early stages of the project. My most memorable experience was watching a baby being born and nearly passing out while observing a gall bladder surgery. Being of Native American decent, it has been wonderful to have the opportunity to work directly with the Native American community and personally gratifying to know that I contributed to help better the lives of my people.

Overall, my entire experience was fantastic. I couldn't ask for better people to work for and I can't wait to get back to school and encourage my peers to apply for a COSTEP internship.

My name is Timara Faulkner and I am about to start my third professional year in the Pharm.D. program at the University of Tennessee. My experience at the Lawton Indian Hospital in Lawton, OK have been great! I have screened prescription orders, entered them in the computer, filled them, and counseled patients. My project was to work with the other intern to develop a ward stock list for the units and that went well. Our lipid clinic started July 1, and was very exciting. The pharmacists here were all great and I learned a lot from them. I didn't have a car, but it didn't matter because the pharmacists were nice enough to pitch in and take me wherever I needed to go. I felt at home from the moment I stepped into the pharmacy.

I saw a baby being born, tubal ligation, mole removal, and colonoscopy. I spoke with various administrators to learn how the hospital is run. Over the summer I shadowed a physician assistant, a pediatrician, and an optometrist here at the hospital. I have listened to two different speakers talk about lipid lowering drugs and a speaker talk about Fosamax. I attended a continuing medical education program in Oklahoma City, OK on AIDS drug therapy and another here in Lawton on ACE inhibitors.

I have also had plenty of fun. I went to Oklahoma City for the Red Earth Indian Festival; Chickasha, OK for a Kiowa Nation powwow; Six Flags over Texas in Arlington, TX; and took a road trip to San Antonio, TX.

So, as you can see, I had a very busy summer. My experience here has been great and I look forward to telling the students at my school about COSTEP and encouraging them to apply. Participating in this program has been one of the best decisions I ever made.

University: University of Kansas

Imagine yourself employed as a clinical pharmacist on an Indian reservation, helping to identify and serve the needs of a uniquely challenged culture. This is where my awesome and experiential summertime journey began! I was selected to participate as a JRCOSTEP pharmacist at the Yellowhawk clinic, located just outside of the Pendleton(Oregon) city limits.

I arrived here in Pendleton armed with my pharmacy reference books, developing pharmacy knowledge, and a strong desire to learn. My appointed preceptor was Chief pharmacist Dr. Allen Jio Captain in the IHS. Dr. Jio is a former graduate of the Indian Health Service(IHS) pharmacy practitioner program. Currently serving as the Clinical Director of the Yellowhawk Health Clinic, Dr. Jio has responsibilities outside of traditional pharmacy boundaries including: development and implementation of clinic programs; personnel management which includes recruiting, hiring, and evaluation of all medical personnel; planning of professional conferences, P& T director; and many other job functions. With his guidance and support I learned a terrific amount about health care delivery and responsibilities within the IHS program.

The IHS team concept among health care workers has become a valuable addition to my own pharmacy experience. Primary care doctors, nurse practitioners, medical technologists, pharmacists, etc., all work together as a team to develop a care plan offering the best possible outcome for the patient. I have participated in and/or observed many different areas of interest while at the clinic. I was introduced to IHS patient counseling techniques, which include using open-ended questions, to allow the patient to demonstrate their own understanding about the treatment program instituted. In most situations the pharmacist is the last medical professional the patient has contact with, therefore, it is vitally important for the pharmacist to make sure the patient understands the treatment regimen prescribed for them.

I have participated in many different educational/professional programs while here at the clinic. These include obtaining CPR certification, attending P & T meetings, developing a drug utilization review(DUR), presenting an informational speech to the diabetic patients, and many other exciting areas in pharmacy.

Taking part in the development of a DUR proved to be very informational and something of a challenge. The criteria established for a DUR can be very specific pertaining to a single area of focus or can be expanded immensely to include monitoring dosage changes, medication changes, compliance issues, etc. My job was to review information from the patient's medical charts and document patient compliance, fasting blood glucose levels, and hemoglobin A₁c values. In addition, information was recorded about initial medication and dosage versus the medication they are now using. Lastly, I entered the patient data in the computer and generated a written report. The report contained a brief evaluation of the results and recommended further action to be presented to the P & T committee.

My last big project was to research new information available about diabetes and present this to the diabetic clinic. Diabetes has afflicted the Indian population at much higher than usual incidence rates. Therefore, a concerted effort is being made throughout the IHS program to aggressively address this issue.

Now at the end of my extraordinary and unique summertime experience, I look back at this as a once in a lifetime opportunity. I have developed many new friendships along the way and look forward in the years to come to renew these old acquaintances. It is now time to return to the University of Kansas and complete my Pharm.D. degree, taking along with me the new knowledge and experience I have acquired over the summer.

University: University of Kentucky

I am currently working toward graduating in May 1999 at the University of Kentucky in the Pharm.D. program. This summer I worked in the Indian Health Center in Miami, OK, part of the Indian Health Service. I kept very busy this summer doing such things as educating diabetics in our diabetic clinic (with some of the new information I learned in school this year), helping kids at the Indian summer camp, writing patient information sheets for the clinic to aid in patient counseling, and updating the medical staff on new recommendations in therapy.

In my spare time I was busy experiencing a new part of the country that I had never been to before. I spent a couple of days in Tulsa sightseeing at the zoo, downtown and museums. I also went to one of the Seneca Tribe's Pow-wow. One of the best experiences was attending a rodeo that a pharmacist at the clinic participated in. I am very anxious to share my wonderful experiences with my classmates when I return to school. I also want to take what I have learned this summer to help me become the best health care professional I can be.

University: Southwestern Oklahoma State University

Hello. My name is Christian Dawes and I spent my summer in the Smokey Mountains at Cherokee, North Carolina. It was a great summer! It was absolutely beautiful living there in the mountains. Cherokee Indian Hospital has a little of everything to offer. I spent my mornings in the inpatient area where the medical staff meets for rounds at 8:30am to discuss patient status and plans for the day. After adjourning rounds, I assist in filling the medication carts and I.V. preparations for the hospital inpatients. I was also given time to work on my individual projects before lunch. In the afternoons, I reviewed patient's charts, filled prescriptions, and counsel, counsel, counseled!! We had two counseling rooms where the patients are called in to discuss their medication therapy. This brief time allowed us to verify the medication with the patient, the regimen of therapy, and any questions the patients had.

I think the best part of this job was the staff. Everyone was super nice and I learned something different from each pharmacist. My preceptor allowed me to choose projects and activities based on my own interests. Another pharmacist also teught me how to be a "clinical pharmacist." We worked extremely hard since the clinic was so busy, but I truly felt that I had the opportunity to help many people this summer. I encourage anyone who is interested in the IHS or looking for a place dedicated to optimal patient care to consider Cherokee Indian Hospital.

As a junior commissioned officer for the Public Health Service, I was employed at the hospital in Fort Defiance, Arizona on the Navajo Reservation. My employment with the Indian Health Service has been both culturally and educationally fulfilling. I spent my time performing various tasks in the pharmacy. I had the opportunity to work in the outpatient and inpatient departments. I also counseled patients and observed how other departments in the hospital operate. Fort Defiance Indian Hospital provides more outpatient services than inpatient services. I would suggest that future COSTEPs spend some time at a larger facility (perhaps a week in Phoenix) in order to gain more inpatient experience. However, Fort Defiance is a great place to become familiar with the duties and responsibilities of a pharmacist. I learned a great deal from the other employees at the hospital and found that this experience has been beneficial for my pharmacy education.

I also enjoyed working with the Navajo people. I learned more about the Navajo culture and the assistance that the Public Health Service provides the Navajo population. The location of Fort Defiance is quite isolated. However, if a person would like to explore the southwest portion of the United States, this area is a great location in which to be situated in order to travel to other destinations. I was fortunate to have been able to explore other parts of the reservation while learning about the customs and traditions of the people. I would recommend that future COSTEPs assigned to Fort Defiance bring a vehicle. I found that having access to a car was helpful in making the stay more enjoyable.

University: Long Island University

I am currently enrolled in the 4^th year of pharmacy curriculum at Long Island University. This past summer, I worked as a pharmacy COSTEP in the Indian Health Service Indian Hospital in Claremore, Oklahoma. It was a very positive experience. I learned more about the Public Health Service (PHS), the responsibility of being a pharmacist, and the hospitality of Oklahoma.

In the past three months, I filled prescriptions, made IVs, filled Unit Dose Carts, and did patient counseling under the supervision of the pharmacists. I was also involved in projects such as Material Safety Data Sheet Inspection, monthly chart review, and educational video programs. I was also a volunteer in a seat belt survey. This was my first exposure to a pharmacy setting. It was overwhelming, yet challenging and fun.

While I was filling prescriptions, I learned about the usual dosage, available strengths, and the disease states that a medication is usually prescribed for. By watching the pharmacist counsel, I learned that dispensing is not just handing the medications to the patient, but helping them to understand what the medication is for, providing answers to their concerns, and helping to ease their anxiety.

This COSTEP experience has strengthened my determination to be a pharmacist. It also gave me an opportunity to find out more about hospital pharmacy. Before I came here, I thought after I graduate, I would be working in a retail setting. However, I now understand there are different opportunities out there for me. I found out that I am interested in the clinical aspects of pharmacy, and the possibility of pursuingt a career in the PHS.

Lastly, I want to thank all of the people that I worked with this summer. They were all very friendly and helpful. I have learned something from every single one of them, and all of them have made me feel welcome. I would like to thank the PHS for giving me such a wonderful experience, and I am looking forward to a COSTEP in the Bureau of Prisons this coming winter, if possible.