Can native speakers transform health care on the Navajo Nation?

Can native speakers transform health care on the Navajo Nation?

The article mentions suicide, which may be triggering. If you or someone you know is suffering from mental illness, emotional distress or concerned about their mental health, there are many ways to get help. If you are in crisis, please contact the 988 Suicide and Crisis Lifeline by calling or texting 988.


There is no Navajo word for “suicide.” Yet children as young as 8 years old at the Gallup Indian Medical Center are thinking about it, said Adeline June, M.P.H. She coordinated the hospital’s suicide prevention program for five years and most recently joined the Crownpoint Health Care Facility on the eastern border of the Navajo Reservation. Health Promotion Specialist.

Gallup Hospital in New Mexico is about two hours west of Albuquerque and nestled between the Navajo and Zuni reservations, making it one of the Indian Health Service’s busiest care facilities.

In the 1700s and 1800s, American Indian tribes were forced to sign treaties with the U.S. government, stripping them of their land and resources. From 1869 to the 1960s, nearly 83% of Aboriginal school-age children were removed from their families and placed in residential schools for assimilation.

“The history of injustice affects our people: I can see it, I can hear it,” explains Joan, who is Navajo, or Diné as Navajo people call themselves. She is also one of nearly four dozen fellows participating in UCSF’s Health, Equity, Action, and Leadership (HEAL) program.

“For example, when we work in the emergency room, most of our patients have a history of trauma, especially at home, where older generations have experienced things like residential schools, racism, assimilation and substance abuse,” Joan said.

In an epidemic that dates back decades, suicide rates in American Indian and Alaska Native communities are three times higher than in the general population. But this is just one of the many health disparities Joan and her team encounter.

The Navajo Reservation is the largest such land in the United States, stretching more than 27,000 square miles across parts of Arizona, New Mexico and Utah. However, according to 2020 data, one in three Navajo households does not have running water, electricity, or both. Scarcity of grocery stores has contributed to high rates of diabetes and obesity. The reservation is dotted with more than 500 abandoned uranium mines, which have contaminated water supplies and homes.

The two-year HEAL Fellowship provides support to health care workers interested in working with underserved communities. Since 2015, HEAL has trained more than 200 clinicians and other health care workers in areas such as leadership, advocacy and social factors that influence people’s health. HEAL operates in 10 countries, but has a special focus on serving the Navajo Nation, which continues to suffer the effects of colonialism, including a lack of access to health care.

About 15 percent of the Navajo Nation gets its drinking water from unregulated sources such as wells, springs and water points—and more than one in ten water sources sampled was contaminated with uranium. There are more than 500 abandoned uranium mines on and near the Navajo Reservation. Photo by Barbara Reese

“HEAL began working on the Navajo Nation because several key UCSF residents had begun working there, and they spoke about the power of the work and reliance on temporary staffing agencies,” said HEAL co-founder and U.C. explains Sriram Shamasunder, MD, professor of medicine at the University of San Francisco. “We know global health needs to focus on health equity regardless of location, so the Navajo Nation is a compelling location.”

To help fill the gap in health care workers on the Navajo Nation and elsewhere around the world, HEAL recruits two types of fellows. Physicians trained in the U.S. can allocate their second-year fellowships at medical facilities on the Navajo Nation reservation or in rural Salinas near California’s Central Valley before joining one of nine countries including Haiti, Uganda and Nepal. One medical institution. In addition, healthcare professionals already working at one of HEAL’s sites around the world can apply to become site fellows. Unlike rotating physicians, on-site fellowships are open to a wide range of staff, from program managers to midwives and nurses. Field Fellows receive training and mentoring alongside Rotating Fellows while continuing to serve their own communities.

Today, a quarter of HEAL fellows are from the Navajo Nation.

The Navajo Nation has one of the highest rates of health care provider vacancies in the nation. HEAL scholarships provide scarce physicians to the Navajo Nation—many of whom choose to stay permanently. Photo by Barbara Reese

What is cultural responsiveness?

In 1958, Taylor McKenzie, M.D., became the first Navajo doctor. Adriann Begay, MD, HEAL’s senior adviser to the Navajo Nation, first met McKenzie when she was 12 at the old Fort Defiance Indian Hospital on the Navajo Reservation . That day, McKenzie asked Begay if he would follow him on a round at the hospital.

“Growing up on a reservation, especially as a beneficiary of the American Indian Health Service, you never saw doctors like you,” Begay recalled. “We walked into the old hospital and there was a patient who was undergoing traction. When we walked up to him, the first words he blurted out were:Yá’át’ééh shicheii, haa lá ánít’é‘ – that is, ‘Hello, grandpa, how are you? ‘”

Begai watched her mother and aunt translate for the mostly white doctors who came in and out of the hospital growing up. But a doctor has never been seen speaking to a patient in Navajo. “Kids can’t dream of being something they’ve never seen,” she said, recalling that moment. “I thought, ‘I can do this, I can be a doctor.'”

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