Bridging the Gap: The Siamit Program’s Journey Towards Rural Health Equity

A collaboration between Indigenous Iñupiat people and researchers aims to improve healthcare in remote Alaska

In the remote region of northwest Alaska, where access to healthcare is limited and the challenges of rural living are amplified, a groundbreaking program called Siamit is working to bridge the gap in healthcare equity. Founded in 2016, Siamit is a collaboration between the Indigenous Iñupiat people and researchers from the Maniilaq Association, Harvard Medical School, and Massachusetts General Hospital. The program’s mission is to connect academic medicine and community care to advance rural health equity. Over the years, Siamit has made significant strides in expanding access to healthcare, addressing workforce development, and tackling social and behavioral health needs in the region.

Expanding Access to Healthcare:

One of the key priorities identified through needs assessments conducted in the region’s villages was the need to expand access to physician care in outlying areas. In response, physicians from Massachusetts General Hospital began working at village clinics and the Maniilaq Health Center in Kotzebue, the regional hub hospital. This on-the-ground presence has allowed for more comprehensive and timely care for the residents of these remote communities.

Addressing Workforce Development:

Another priority identified by the community was the need to address workforce development in the region. To meet this need, Siamit developed a medical-resident rotation program at the Maniilaq Health Center, providing physicians with the opportunity to gain experience in rural health and encouraging them to pursue careers in this field. Additionally, a postgraduate research fellowship was established for early-career Indigenous health workers, further strengthening the workforce and fostering a sense of ownership and leadership within the community.

Tackling Social and Behavioral Health Needs:

Siamit recognized the importance of addressing social and behavioral health needs through the primary care system. By integrating research components into various healthcare programs, Siamit aims to inform program design and evaluate their impact. Programs in primary care, emergency medicine, psychiatry and addiction medicine, women’s health, and social medicine have been established, with a focus on improving care delivery and meeting the unique needs of the community.

The Principles of Community-Medicine Projects:

Throughout the development of Siamit, several principles have guided the program’s approach. Firstly, governance is key, with rural communities leading partnerships to address their own needs. Indigenous health research, in particular, requires attention to governance systems and sovereignty, given the history of knowledge extraction and exploitation. Secondly, health research in under-resourced communities should prioritize tangible improvements to health and healthcare, focusing on understanding local contexts, needs, and concerns. Finally, the value of academic-rural health partnerships grows exponentially when a certain level of integration is achieved, creating an ecosystem of relationships, projects, and priorities that is community-governed.

The Future of Rural Health:

While rural communities may be geographically distant from traditional centers of health research and training, they possess high levels of community engagement, strong social networks, and innovative health systems that align with the goals of academic medicine. As Siamit continues to make strides in rural health equity, the program envisions a future where academic clinicians choose to base their lives in rural and remote communities. This symbiotic relationship between rural priorities, clinical need, and academic mission has the potential to transform lives, careers, and institutions, ultimately leading to a more equitable healthcare landscape for all.


The Siamit program in remote Alaska serves as a shining example of the power of collaboration between communities and academic institutions in achieving health equity. By addressing the specific needs of the region, expanding access to healthcare, and fostering a sense of ownership within the community, Siamit has made significant strides in improving the health and well-being of the Indigenous Iñupiat people. As the program continues to grow and evolve, it offers valuable lessons for the future of rural healthcare, emphasizing the importance of community-led governance, tangible improvements to health, and the integration of academic and community priorities. Through these efforts, Siamit is paving the way for a more equitable and inclusive healthcare system in remote areas.