SALEM, Ore. – The COVID-19 pandemic, on a universal scale, became a reality check for numerous critical factors of the U.S. healthcare system. Three years ago, these regionally diverse systems, whether they were large or small, quickly became strained under the increased workload and oftentimes struggled to absorb the sudden and increased burdens of serious patient care.

Oregon National Guard doctors and medical care service members found themselves pulled in multiple directions at times, working in the community – both in uniform and in their civilian capacities. The challenges can be complex with demanding dual careers; both focusing on providing patient care, and each requiring a balanced approach with a supportive team.

These military doctors bring a wealth of experience and a range of skills to insure mission readiness. They also follow a devoted calling, of providing care to injured soldiers, dating back to the nearly 1,400 practitioners that served in the Continental Army.

Taking on these demands over the past decade, Oregon Air National Guard Col. Damon Armitage has been able to balance the ‘ebb and flow’ between the two.

“The reality is, there is no such thing as being a traditional guardsman in a senior leadership position…it might be that on paper, but the time commitment is going to be that much greater to stay actively engaged with the unit,” said Armitage.

After graduating from the University of Arkansas Medical School-Little Rock, in 2005, Armitage began his medical career in the Air Force during three years of residency work in family medicine at Travis Air Force Base, California, in a University of California-Davis affiliated program in 2008. He stayed on active duty until 2012, when he and his family decided to come back home to Cottage Grove, Oregon.

Working as a family medical care physician, he is the co-founder of the Camas Swale Medical Clinic, which opened in 2017 near Cottage Grove, with a patient population of over 3,000. Managing his time between the clinic and in his role as the Medical Group Commander for the 142nd Wing can be a balancing act at times, he said.

“It’s very rewarding, and every bit as much work as I thought it would be when I decided to pursue both jobs as a medical provider and officer,” he said, describing the adjustment of both jobs. “With my role in the Wing and state leadership, I also get a great deal of satisfaction when providing good mentoring and fostering the development of the next generation of Airmen…to me, that’s the most important thing we can do; leave it better than we found it.”

Knowing how much time it would take to get his private practice off the ground, he volunteered for several deployments in a row, covering assignments for other 142nd Wing doctors. “The staff is well-balanced, as we back each other up and make sure our unit mobilizations are covered well in advance.”

The deployments over his military career have taken him around the world; from Afghanistan as a flight surgeon, to Burkina Faso, supporting nation-building and community stabilization, and in 2017, supporting Operation Atlantic Resolve in Romania, ensuring 142nd Wing pilots were safe to fly.

“During my deployment to Africa, we were living on the economy, developing personal connections while training local providers, which allowed me to utilize my French language skill too,” he said. “While working with the State Department, we provided assistance at an orphanage, getting them the supplies they needed and setting up a mobile clinic.”

These deployments to other countries offer an additional benefit for medical professionals, as they work with infrequent issues among diverse populations.

“As a medical provider, you need a good scope of practice, especially for our younger and active duty doctors,” Armitage said, noting that these deployment experiences offer those unique opportunities to develop new aptitudes. “If all they are seeing is good healthy young people within the garrison environment, they are not seeing a significant disease burden in the population to maintain their skill sets of management in complex medical diseases states.”

Throughout the height of the pandemic, these disease-burdened members of the population became a center stage, as vulnerable and older members of the population faced the greatest overall health threats. These were also perilous concerns for Col. John Maddox, the State Surgeon for the Oregon National Guard. Faced with the rapidly changing data and rising case count, the overall health of the force became his crucial focus.

“Being a state surgeon in a pandemic is bad timing,” he said, now looking back three years ago with a slight jest. “There was so much unknown early on and we were learning on the fly, but as I told our staff and our service members – hopefully we will never see this again.”

For Maddox, his military career began in 2000 when he joined the Army Reserves, but in many ways, he was influenced by his father’s service in the military.

“Like a lot of folks who serve, I had family in the military and my dad was a physician and a surgeon in Vietnam,” said Maddox, reflecting on his early career in uniform. “During my first deployment, I was a trauma surgeon with a forward surgical team in Iraq from 2003 to 2004. When I got back from deployment, I was looking to serve in a more operational unit. That’s how I found the Oregon National Guard…when the 1-82 CAV Commander, then Maj. (William) Prendergast, recruited me.”

As a board-certified general surgeon with a specialization in Colon and Rectal surgery, he lives in Colorado and serves as a chief medical officer and administrator for a private medical business in Puyallup, Washington.

“I still enjoy being in the operating room, there is something very amazing and magical about seeing the human body from the inside,” he said. “Yet I feel that I peaked as a surgeon on deployment; the challenges and situations had a way in heightening my abilities.”

Over his career, Maddox has noticed how much the business of medicine has changed with various regulations, overall costs, and factors regarding health insurance and access to care. He’s also noted philosophical approaches to health care among various age groups now.

“It’s very generational if you talk to an octogenarian…they’ll take what you have to say with more perceived acceptance, “Yeah, you’re the Doc, you know what’s best,”….and if you talk to a millennial, they will show up to an appointment with a print out from the web with data and questions. It’s really interesting to see the full range.”

This was also evident to Maddox when the Oregon National Guard was operating max vaccination sites. As the COVID-19 Task Force Commander, he said the National Guard members operated an impeccable system functioning in the community, working alongside their civilian counterparts and providers.

“When we opened the first vaccination site in Salem, people came in and were in tears,” he said, remembering the initial vaccine rollout. “They were getting something that gave them the ability to see their grandchild. They were emotional and relieved to get the vaccine.”

Not only were older and venerable members of the community thankful for having the vaccine, but they also had a sense of reassurance from Guard members providing direct support to the community.

“Just the presence of the Guard made a difference, if you looked at the drill floor in Salem when we first opened that site, and you looked at the Guardsmen – Air and Army members there – it was just table after table…as far as you could see.”

This work in the community, where he could see his staff grow and take on new responsibilities made the difficult challenges and long days fulfilling.

“Being in the National Guard, for most members over the past years, it’s not a weekend job. And as any other commander, in every other unit can tell you – it’s an everyday responsibility.”

Much like Col. Maddox, many members of the military following in the footsteps of previous generations. When Maj. Jacquelyn Dunn enlisted in the Army National Guard in 2003, she not only joined the Oregon Medical Command like her father but was extending a long legacy of family members who served before her.

“I grew up in Hermiston, where a lot of my friends joined (the Guard) too, and became a ‘68 Gulf’, working as a medical technician,” she said. “My dad [Col. Mike Dunn] was the deputy State Surgeon, and I am the seventh generation of my family that’s continually served.”

After completing her undergraduate studies in 2007 at Willamette University, in Salem, she worked full-time for the Medical Command (MEDCOM), running the post-deployment health reassessment and other areas of services of the department.

“The job allowed me to grow programs…it was great,” Dunn said, recalling her development as a Non-commissioned officer while working toward new goals. By 2009, she had been commissioned as an officer and took advantage of education programs in the National Guard for her medical degree through Arizona College of Osteopathic Medicine in Glendale, Arizona.

“The military has been good to me, and for a short period of time, there was a three-year scholarship through the guard that was available and reduced my loans by 50 percent,” she said. “I joined at the right time because there have been great benefits to serving, even part-time.”

Yet reflecting on why she continues to serve, Dunn quickly points out – ‘it’s all about the people.’

“I like the diversity compared to my primary care job, it’s the best aspect,” she said. “I continue to learn and grow in an environment with people who have different perspectives and experiences.”

As one of only two women in MEDCOM, she’s also seen some of the delays that women often encounter, “just by being a mom,” saying, from the experience with her own three children…“progression is difficult when raising a family, there are certain opportunities for advancement and course work you just miss out on, but with remote training increasing, this is one-way things are getting better.”

In her civilian career, Dunn works for Legacy Medical Group – Northwest, in Portland, focusing on outpatient and internal medicine. She works with her Oregon Medical Command teammate, Lt. Col. Kenna Wood, having referred her to the employer.

“She’s an amazing advocate and mentor,” Dunn said of the only other female physician with MEDCOM. “We relate to the tempo of having a guard career and a civilian career, and that known history of ‘doing hard things’ with other veterans.”

For her part in the military, Lt. Col. Wood has served in the military for nearly 35 years, enlisting with the Louisiana Army National Guard in 1988. She completed her undergraduate work in Biology at the University of New Orleans and then medical school in Florida with an Osteopathic specialty, but eventually transferred to the Oregon Army National Guard during her residency at Good Samaritan Hospital in Corvallis.

“I was an NCO…all the way,” admitting with a laugh, saying that she always envisioned herself as, “that crusty Sergeant…being one of the troops, and taking care of my soldiers.”

Along the way, Wood worked for 10 years as an Active Guard Reserve (AGR) enlisted member and was activated in 1991 for Operation Desert Storm in Saudi Arabia, then later forward deployed into M.A.S.H (Mobile Army Surgical Hospital) field unit in Iraq. When she completed medical school in 2006, she was working toward her officer commission. In 2019, she later deployed to Djibouti and Somalia as a member of the Oregon MEDCOM.

“Well you can’t be a medical physician and still be enlisted so I was at a crossroads,” said Wood. “I thought about retiring then, but I was still enjoying the job, and love the comradeship I get out of serving in the National Guard.”

In private practice, she recently was promoted to a Medical Director position at Legacy Northwest Clinic, focusing her work on internal medicine with a specialty in obesity consulting.

“I get a lot of fresh ideas in the military environment, and some I use in my civilian job,” Wood said, comparing the parallels and differences in her patients. “Some of the Army skills in exercise and training I can use in business, but I’ve seen what the Mess Halls were like in the 80s, that’s been revolutionized from the ‘starch, starch, starch’ dietary menus.”

She’s also noticed other post-pandemic medical trends with her patients. These are challenges that medical providers are now paying closer attention to as well.

“Depression and anxiety now are increasing factors into people’s health, and are underlying factors to other medical disorders,” said Wood. “There isn’t any one reason – but there is a notable difference from just even nine or ten years ago.”

With a demanding career and decades of providing medical care, Wood isn’t slowing down and has a new goal in mind. She recently started school again in January, with an eye toward owning her own business.

“I can’t be still, I like new challenges so I recently began an M.B.A. program…trying to determine if I am going out on my own at some point,” she said. “For me, I guess you could say that my work is my hobby.”

Lengthy military careers for medical doctors in the Oregon National Guard are not uncommon, even with deployments, ongoing short-term assignments, and mandatory training required for all members. The reasons for staying well past a ‘normal 20 years,’ vary from member to member, and often there is a sense of “paying it forward.”

When Col. Jonathon Park was growing up in Korea, his family immigrated to the United States when he was just six years old. It was several years later that his older brother would help plant the seeds of military service, while his family was adjusting to their new life in Los Angeles.

“My older brother was in the U.S. Army in the early 1970s, so this was my first introduction to the military,” said Park, remembering how impressed he was with the change in his brother. “He came back from basic training on leave and he had a different attitude and mindset. His physique had changed too, and he took me up to the trails for a workout around Griffith Observatory one day before 6:00 a.m., running up and down in the hills.”

Taking advantage of his desire to attend college, Park completed his undergraduate studies at the University of California at Santa Cruz, then later completed medical school in Puerto Rico. While completing his medical training in Pennsylvania, he joined the Army National Guard.

“I could have never done this in Korea because back then, you either had the means or you didn’t. If it hadn’t been for America I would have never had that opportunity to pull myself up…socially.”

After four years as a practicing physician in the Midwest, he returned to the West Coast, moving to Coos Bay, Oregon, 21 years ago and became a member of the Oregon National Guard. His practice is in family medicine, working for North Bend Medical Center, at a satellite office in Bandon.

“For me, I am the kind of physician that looks at health holistically; whether it be how someone approaches life through work, task, or even a certain profession,” he said. “It’s looking at the whole spectrum of medicine – from birth to death.”

“The time came when I knew I wanted to pay America back – somehow…as my new country,” Park described, saying that joining the military was a way to serve and defend his adopted nation. “I serve to maintain peace, to defend democracy…this is my calling in the military, to take care of our troops as a physician.”

During his nearly 30 years of military service, Park has deployed five times, taking on some of the most notable and daunting assignments by the U.S. military over the past three decades. His most recent was in 2020, where he was in charge of Covid mitigation protocol during the initial phases of the pandemic, mitigating how the virus would impact soldiers and civilian populations in Djibouti and Somalia.

“I was tasked to identify American and civilian contracts who are all over the Horn of Africa, and see if they were at risk of developing complications of Covid,” he said. “We needed to quickly identify high-risk cases and get them out of the country for treatment. With the public health risk, we self-isolated and experimented with ways to avoid threats early on with the virus.”

He has also deployed twice to Iraq, with his first assignment in 2004-2005, and then with the 21st Combat Support Hospital, out of Ft. Hood, Texas, in 2010, which processed more than 2,500 emergency room visits during the nine months of operations in Mosul. By 2013, Park found himself working with many of his former Pennsylvania Guard members in the 20th Infantry Division when deployed to Kuwait.

“In each of these assignments I had various roles, but providing direct medical care to our troops was always a primary concern,” he said, as each deployment built skills and knowledge for future missions.

One of those significant assignments was his deployment with the 41st Brigade in 2006 to Afghanistan. While visiting an isolated area in Saharan, he quickly realized an urgent need for a troop clinic.

“They had only one medic that made the rounds just once a week,” Park said, describing the state of operations in the area. “I contacted Col. (Mike) Dunn, the Chief medical liaison for 41st Brigade to establish a treatment site to be established there.”

With the assistance of the Navy’s Seabees, the Aid Station in Sharana helped treat coalition forces, contracted civilians, and Afghans, establishing direct care from the medical staff that would later be assigned to the region.

“It was gratifying to know we had left a legacy behind after our assignment, where we could take care of our troops in a much-needed province.”

In many ways, Lt. Col. Minh Ho shares a similar story to Col. Park. When Ho left Vietnam in 1992, he was only 14 years old, and like his father who served in the military, he joined the military too, giving him the opportunity to strive toward his goal to become a doctor while serving in the U.S. Air Force. With the assistance of the Health Professions Scholarship Program (HPSP), he attended Albany Medical School in Albany, New York, and completed his residency requirements at Travis Air Force Base, California.

“I love being in the military,” said Ho. “I’ve been able to travel, serve my adopted country, and help our Airmen sustain their military careers.”

Other duty assignments for Ho have included Keesler Air Force Base, in Mississippi and Joint Base Lewis-McChord in Washington.

After serving for seven years on active duty, and deployment to Qatar in 2010, Ho wanted to spend more time at home. He joined the 142nd Wing and is currently in a supervisory role as a Flight surgeon.

“I thought for a long time about staying on active duty for a twenty-year career, but decided that I wanted to begin my civilian medical career too,” he said, describing why he joined the Air National Guard. “It’s enjoyable doing both. Right now I work on the operations side, making sure our pilots’ are mission ready, and how they are doing on a case-by-case basis.”

He has been working for the last seven years in family medicine for Kaiser Permanente, with a focus on public health and infections. Though he wasn’t activated on military orders during the pandemic, he was still seeing a steady caseload, especially during the Omnicom variant surge.

“I am getting close to retiring from the military, yet the opportunities that I’ve had for special training that the Air Force offers have made it beneficial.”

Some of those unique opportunities can come in Hyperbaric training and studying the risk of sudden depressurization, as well as space medicinal course work – including studying the effects of working in austere environments that pilots might be subjected to in combat.

In total, the benefits of having a dual career provide irreplaceable dividends during a physician’s career in research and patient care treatment. Characterizing why many doctors serve for long careers in the Oregon National Guard, Col. Armitage said, as it comes down to a sense of “camaraderie and serving others.”

“It’s always the people. The mutual support and professionalism that’s here [on base] is really something I have rarely experienced anywhere,” he said. “It’s hard to walk away from that – we all want to give something back.”