Howard Welsh, ARNP resides in Forks, WA where he does primary care for local residents, many of whom are loggers, truckers, and fishermen or longtime members of the local tribes engaged in subsistence activities. There is a sizable community of locals working in the forests gathering salal, mushrooms, and recycling cedar for roofing shakes.
There is one grocery store and two hardware stores. There is a Head Start and an elementary and secondary school system. Along Highway 101 there are some restaurants and motels with service workers, cooks, and waitresses. There are a few state and federal employees as well. This makes for a diverse population of patients.
There are serious alcohol and polysubstance problems and seemingly intractable poverty-driven health problems with every kind of social and mental health problem imaginable. Residents watch the logs being loaded onto trucks and driven to the ports in Port Angeles and Aberdeen-Hoquiam and loaded onto ships headed overseas, where they are milled and processed – work the local residents used to do for decent wages.
In a community like this, Mr. Welsh is expected to do everything, so integration of healthcare is a necessity. According to Mr. Welsh, “The local people just don’t get any mental health care, or any care at all, without the integration of the clinic services wth the local agencies which are bare bones. It is good that an old curmudgeon such as myself is here trying to provide some patient advocacy where it is otherwise lacking.”
Since Mr. Welsh enjoys being a nurse, as well as fishing/ hunting/hiking, he will continue working here until something “forces him into retirement.”
Mr. Welsh appreciates the UW for helping him be a better provider and actually giving him the instruction he needs to keep working effectively in this environment.