Can Native Speakers Change Health Care on the Navajo Nation?

Can Native Speakers Change Health Care on the Navajo Nation?

This article contains references to suicide, which may be inciting. If you or someone you know has a mental illness, is struggling emotionally or has concerns about their mental health, there are ways to get help. If you are in crisis, call or text 988 to connect to the 988 Suicide and Crisis Helpline.


There is no word for “suicide” in Navajo. However, it’s on the minds of children as young as 8 at Gallup Indian Medical Center, says Adeline June, MPH, who coordinated the hospital’s suicide prevention program for five years before recently joining Crownpoint Healthcare in the eastern boundary of the Navajo Reservation. a health promotion specialist.

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

During the 1700s and 1800s, American Indian tribes were forced to sign treaties with the American government, robbing them of their land and resources. From 1869 to the 1960s, nearly 83% of indigenous school-age children were taken from their families and placed in boarding schools to assimilate.

“The history of injustice affects our population: I can see it, I can hear it,” explains June, who is Navajo, or Dine as the Navajo call themselves. She is also one of nearly four dozen fellows who are part of UC San Francisco’s Health, Equity, Action and Leadership (HEAL) Initiative.

“When we worked in the emergency room, for example, most of our patients had a history of trauma, especially at home with older generations who experienced things like boarding schools, racism, assimilation and substance use,” says June. .

In an epidemic that stretches back decades, suicide rates among American Indian and Alaskan communities are up to three times higher than among the general population. But that’s just one of the many health disparities June and her team encounter.

The Navajo Reservation is the largest such tract of land in the US, encompassing parts of Arizona, New Mexico and Utah and spanning more than 27,000 square miles. However, 1 in 3 Navajo families live without piped water, electricity, or both, according to 2020 data. Grocery stores are scarce, contributing to high rates of diabetes and obesity. And the reservation is dotted with more than 500 abandoned uranium mines, which have contaminated water supplies and homes.

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

About 15% of the Navajo Nation obtains its drinking water from unregulated sources such as wells, springs and watering points – more than 1 in 10 wells sampled were contaminated with uranium. There are over 500 abandoned uranium mines on and near the Navajo reservation. Photo by Barbara Ries

“HEAL started working on the Navajo Nation because some key UCSF residents had started working there and they talked about the labor force and dependence on temporary staffing agencies,” explains HEAL co-founder and UCSF Professor of Medicine Sriram Shamasunder. , MD. “We knew that global health had to be about health equity regardless of location, so the Navajo Nation was a compelling location.”

To help fill health care worker gaps in the Navajo Nation and other countries around the world, HEAL recruits two types of fellows. U.S.-trained doctors can split the second year of their fellowship between health care facilities on the Navajo Nation or rural Salinas, near California’s Central Valley, before joining sites in one of nine countries, including Haiti, Uganda and Nepal. Alternatively, healthcare workers already working at one of HEAL’s sites around the world can apply to be a site associate. Unlike rotating doctors, field fellowships are open to a wide range of employees, from program managers to midwives and nurses. Site associates are trained and mentored alongside their fellows while remaining to serve their communities.

Today, a quarter of HEAL’s fellows come from the Navajo Nation.

The Navajo Nation has one of the nation’s highest vacancy rates among medical providers. The HEAL Association provides the Navajo Nation with scarce doctors—many of whom choose to stay permanently. Photo by Barbara Ries

What is culturally responsive?

In 1958, Taylor McKenzie, DO, MD, became the first Navajo physician. Adriann Begay, MD, senior advisor to HEAL’s Navajo Nation, was 12 years old when she first met McKenzie at the old Fort Defiance Indian Hospital on the Navajo reservation. That day, McKenzie asked Begay if she wanted to shadow him on hospital rounds.

“Growing up on the reservation — especially as a recipient of the U.S. Indian Health Service — you never saw a doctor who looked like you,” Begay recalls. “We entered the old hospital and there was a patient in withdrawal. He walked over to him and the first thing that came out of his mouth was:Yá’át’ééh shicheii, haa lá ánít’é” – which is, ‘Hello, Grandpa, how are you?’

Begay had watched her mother and aunts translate for the mostly white doctors who came and went from the hospital while growing up. But he had never seen a doctor address a patient in Navajo. “Kids can’t dream of being something they’ve never seen,” she says, reflecting back on that moment. “I thought, ‘I could do this, I could be a doctor.’

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