April 27, 2022 by Jessica Gee
Karen Holder, FNP, is retiring from her long career as a nurse.
Karen’s long and colorful legacy includes being part of the team that started North Country HealthCare in 1991.
Read on to hear more of Karen’s story of treating high-need patients across the country!
At North Country HealthCare, we believe every person deserves easily accessible, quality healthcare delivered in an atmosphere of respect. Karen Holder, one of our family nurse practitioners, has been embodying this belief since our beginning. In the 30-plus years that Karen has been an integral part of the organization, she has served hundreds of patients with her special brand of compassionate care.
Her passion for our mission and dedication to our patients are an inspiration to her teammates. It’s obvious to anyone who sees her in action that people are at the heart of everything she does. In honor of her upcoming retirement, we wanted to recognize her contributions to not only North Country HealthCare, but to the countless underserved and marginalized people she has helped over her many years as a healthcare professional. Read on for our full interview with Karen Holder, FNP.
I grew up in a tiny farm town in the Midwest. My parents were divorced and we spent much of our childhood with our grandparents. They raised my two brothers and me, along with a few of our cousins. The richness of being raised by a “village” is something I deeply value.
My mom was an obstetrician nurse. Being in a rural area, she was the only healthcare professional for miles, so she would get all kinds of health-related calls. The care she provided for many in our community sparked my interest in helping the underserved. As I pursued my interest in healthcare, I became captivated by the idea of being a barefoot doctor like my hero, Dr. Tom Dooley.
An eye-opening experience at Indian Health Services
I wanted to be a nurse since childhood. My motivation was sincerely to help people. I went to a college near the town I grew up in, and in my senior year, I had the good fortune to meet the head nurse for Indian Health Services. I told her I wanted to go to Alaska and fly in and out of small villages delivering nursing care. She looked at the wide-eyed naïve youngster before her, took my hand and said, “Honey, I will put you anywhere you want to go in the lower U.S. If after a year you still want to go to Alaska, I’ll do my best to make it happen.”
My cousin, who was a medical student at the time and who had gotten me the interview, suggested I go to the Southwest. I’d never been more than 200 miles from my home. Together, we looked at a map of Indian Health Services sites and chose Tuba City, Arizona. I applied, and several weeks later I received a letter stating I was offered a job on the pediatric ward in Tuba City.
When I arrived in 1975, I was one of three Caucasian nurses. We were placed in a house on campus as roommates. Within a year, another handful arrived, including a few doctors who had opened a new hospital. I was a recent graduate, working nights as a head nurse on this huge pediatric ward of 35 beds, and honestly, didn’t know a thing! I learned everything from the wonderful Native American nursing assistants.
Kids in crisis: Plague, tuberculosis, rattlesnake bites
In those days, children would be brought in by families from long distances, who often believed the children would die in the hospital. Unfortunately, many of them did. They were afflicted by dehydration, infectious diseases such as shigella, the bubonic plague, tuberculosis and meningitis. We also received infants and children severely burned and little ones who had been bitten by rattlesnakes. Most of the time we were over capacity with 40 or more patients on the ward.
Those who survived and healed stayed with us until field health nurses could find and convince families to come get the child. This is not a judgement on anyone, I say this to share the sad story of how our cultures were so foreign to each other. At the time, there was little trust or understanding of each world. That is why these little ones would not be brought in until they were quite ill and why they needed ceremonies after being in the hospital before they could reintegrate back into their homes.
During my time in Tuba City, I started different programs such as educational sessions for nurses. My efforts were recognized by the service unit director, who in 1977 suggested I apply to a new program that was training nurses to become certified physician assistants or nurse practitioners. My dreams of being a barefoot doctor and my youth were strong motivators to apply, but there were hundreds of applicants to the program so I didn’t give it much hope. I was floored when I was accepted as one of 16 students to a new decentralized physician assistants/nurse practitioners program at UC Davis. I moved with my partner to San Francisco and worked in an army hospital as I started the program. The second year I did my training in Tuba City and traveled for course seminars once a month.
“My barefoot doctor dream had come true!”
After graduation, I moved back to Tuba City where I worked part time in the pediatric outpatient clinic. I also worked part time as the first field health nurse practitioner, starting clinics in rural communities across the Navajo reservation. Additionally, I did home visits with Jake, my interpreter, and I worked in already established clinics in outlying communities. I would see 30 to 60 patients a day after driving 50 to 90 miles over mud and dirt roads, with a radio as my only communication with other medical staff. My barefoot doctor dream had come true! I thoroughly enjoyed the work and fell more deeply in love with the Native people, who quickly accepted me as a part of their communities.
I met my husband in Tuba City, and in 1983 we left to finish his training. We moved to Massachusetts, where I worked at an inner-city federally qualified health center. Nurse practitioners, family practice residents and staff physicians all worked together as capable providers and faculty for the students and residents. It was my first experience with what we now call inter-professional education and teams.
I had a huge practice with hundreds of families. It was in the era of HIV, when many of our patients were dying, and we didn’t know much about HIV, which was very similar to the early COVID days. During this time I helped start a Safe Child Program for sexually abused children. We worked to have legislation passed that allowed children to be videotaped rather than having to appear in court when their abusers were prosecuted. Developing that program and treating HIV have been the most powerful challenges of my career.
Once my husband’s training was done, we moved to Sacramento, California, where he did a fellowship and I worked with migrants in a federally qualified health center. I also went back to school for midwifery. From there, I worked in the perinatal program serving marginalized women delivering babies and doing some family nurse practitioner work in their HIV program.
The part-time job that changed everything
Our next adventure was a move to Flagstaff in 1990 with our three little boys in tow. I got a job at Kinlani Dorms, a boarding school for Native American high school students. With the help of our fabulous staff, we created a full scope adolescent health program, which included and emphasized cultural roots. One of my favorite projects there, and there were several, was a National Institutes of Health-sponsored science competition, which our dorm students entered. The project was to create a Native healing environment out of my little clinic office. We won second place in the nation and I was so proud of the students!
During those early years, I worked part time with a wonderful physician who helped me become the first family nurse practitioner to break into primary care in Flagstaff. I also helped start the Flagstaff Community Free Clinic on Rose Street, which is now known as North Country HealthCare. I worked as the Clinic Director until we hired others, including Ann Roggenbuck. I was then in and out as a volunteer until around 2004, when I began working full time to start an obstetrician program. Jorja Nackard was our translator and Dr. Thomas was my backup OB. Jill Zurowski was hired a year or two later as our first full-time OB and the department has continued to grow tremendously since then!
I have seen so much in my time as a healthcare professional. From traditional Native American ceremonies and “sings” to complex conventional surgeries done with very little staff or equipment, I have witnessed many different ways of healing. Early in my career, I learned the true power of the human spirit. I also learned that there are many ways to heal and an abundance of modalities that help people heal. I think my style could honestly be described as “meeting people where they are” and being a guide and teacher as well as a trusted provider. Trust is essential to me, as are the relationships I develop with my patients and colleagues.
I would have to say the staff! Folks who work at North Country are some of the most dedicated, awesome people I have ever known.
I am also excited to see the Angel Fund grow, as it has been making such a difference in what we are able to do for patients. For example, I had a young, pregnant single mom of three come in with a mass growing on her thyroid. I suspected the mass was cancerous. She worked part time at a fast food restaurant but was uninsured. Emergency coverage under the Arizona Health Care Cost Containment System [AHCCCS] would cover her delivery but not referrals, tests or other necessary care. I wrote a letter to the Angel Fund committee, and they not only covered testing, but the consult and surgical costs as well. It turned out to be cancer, so these procedures covered by the Angel Fund quite literally saved her life.
My hope is that we find kinder ways to support each other as valued healthcare workers and that we nurture and teach our future healthcare workers to meet patients where they are. I also hope North Country continues to support collaborative teamwork so that current providers can carry on the important work of mentoring future healthcare workers to work together as teammates rather than competitors. I would also add to my wish list that our North Country family persist in overcoming the challenges created by the many regulations and indirect care responsibilities to continually and fully live our mission each and every day in every patient and colleague interaction.
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