Audio Country doctor comeback (story audio) Photos Dr. Rup Nagala Dr. Vani Nagala Moe Bohannon View full slideshow (4 images) Respond to this story Talk about this story in the MPR News Forum Submit a commentary Help us cover this story

Country doctor comeback
by Bob Reha, Minnesota Public Radio
November 19, 2002

Dr. Rup Nagala has been practicing medicine in Oakes, North Dakota since 1978 (MPR Photo/Bob Reha)

Health care in rural areas is often limited. It's uncommon for a small town to have a doctor or a hospital. But in Oakes, in southeastern North Dakota, the community is bucking that trend thanks to the efforts of a husband-and-wife team of doctors.

Oakes, N.D. — It's a busy day at the Southeast Medical Center in Oakes. A steady flow of people visit the clinic. Most of the patients are older folks. They're here to see Drs. Rup and Vani Nagala. Born in India, Dr. Rup Nagala came to North Dakota more than 20 years ago. He finished his residency in Minot. Then he was recruited by local business people to staff the clinic in Oakes. His wife, Dr. Vani Nagala, joined him in 1984.

In addition to the medical center, the Nagalas own and run six other clinics in the area. The operation employs three other doctors, seven physician assistants and 75 other people. The clinics care for 20,000 patients. It's a large operation especially in an isolated rural area. Dr. Rup, as the locals call him, says his philosophy of care is simple.

	Dr. Vani Nagala

"I believe that the health care is best given as close to a patient's home as possible. I think that really helps the patient out. I think they recover better. It's easier for the relatives to visit them and personally for the morale or even just to get better I think it just makes sense that a patients care be given as close to home as possible wherever that home is," he says.

For nine years, the Nagalas were the only doctors in town. To lighten their workload, they decided to hire physician assistants. They recruited nurses from towns where they had satellite clinics. And the Nagalas offered to pay for their schooling in return for a job at the clinic.

Dr. Vani Nagala says the couple saw a need and decided to fill it. "I think it just comes naturally, I never really sat down to thinking why I do what I do; it just seems like there's a job to be done and you just do it," she says.

But there are challenges. Clinic administrator Terry Kelly says finding doctors to work in rural areas is a chore. Kelly says there's a federal program that helps. The program is offered to foreign-born doctors whose immigration status is referred to as J-1.

"A J-1 physician has to complete three years in an underserved area or a HPSA area -- health provider shortage area. After they complete the three years, then they get a waiver and they can stay in the United States, otherwise they have to return to their home country for at least three years before they can come back to the states and practice," according to Kelly.

	Moe Bohannon

Duane Shelton is at the medical center for a checkup. Shelton recently had hernia surgery. He says knowing quality care is available close to home gives him piece of mind.

"It's great relief to know it; I mean it's very, very important. We're just glad to have him and the whole setup here," says Shelton.

The system of clinics serves six neighboring communities, some up to 50 miles away. That might not seem like a great distance until you're facing a medical emergency like a heart attack or trauma injuries from a car crash.

Brad Burress, chief operating officer of the Oakes Community Hospital, says the clinic system keeps the hospital open.

"About 50 percent of our business comes from the Oakes area and 50 percent from outside the Oakes area. And that is probably a bit unusual for a small hospital; you'd be a little bit more geared towards the local folks," says Burress.

Burress says the doctors also staff the hospital's emergency room 24 hours a day, a service most small hospitals can't afford. The quality of health care is paying off in another area.

Moe Bohannon, president of the local chamber of commerce, believes access to quality care is one reason Oakes gained population in the last census.

"This also means that for economic development we can become a hub for the senior population that maybe doesn't want to move to the Fargos, the Bismarcks; you know they want to stay in that small-town atmosphere," according to Bohannon.

Bohannon says the Oakes community realizes the clinic wouldn't be there if not for "Dr. Rup." In a show of appreciation, the community has nominated Dr. Nagala for country doctor of the year.

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