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Introduction to the Global Health Scholars Program - Arizona

November 06, 2024
ID
12313

Transcript

  • 00:00Hi, everybody. My name is
  • 00:02Chris. I graduated from the
  • 00:03primary care program last year.
  • 00:05I took a primary care
  • 00:07job,
  • 00:08at Columbia in New York
  • 00:09City where I've been the
  • 00:10past couple months. So,
  • 00:12excited to talk about my
  • 00:13time at Chinle.
  • 00:16I went there during my
  • 00:17third year,
  • 00:18rotation.
  • 00:19These are some pictures.
  • 00:23This is,
  • 00:24Chinle Canyon,
  • 00:26which is located right outside
  • 00:28of the town.
  • 00:29Just for some,
  • 00:31perspective, this is
  • 00:33in Arizona. Yes. Eastern Arizona.
  • 00:36So it's a really pretty
  • 00:37canyon. It goes on for
  • 00:39miles.
  • 00:42Chinle, Arizona. It's it's located
  • 00:44in Navajo Nation. It spans
  • 00:45three different states. So Arizona,
  • 00:48Utah, New Mexico. It's about
  • 00:50three hours from Albuquerque,
  • 00:52five hours from Phoenix.
  • 00:54You really do need to
  • 00:55rent a car,
  • 00:57and you you share a
  • 00:58house with another,
  • 00:59another resident,
  • 01:01or I think med students
  • 01:02also go there.
  • 01:04This is a picture of
  • 01:05the house that I shared.
  • 01:06Actually, it was it was
  • 01:07pretty nice inside.
  • 01:08It was just me and
  • 01:09another, you know, resident.
  • 01:12There is a ton to
  • 01:15do in the American Southwest.
  • 01:18I was born and raised
  • 01:19in the northeast, so everything
  • 01:21that I saw out there
  • 01:22was was, spectacular.
  • 01:25This list, I pretty much
  • 01:28drove to all of it
  • 01:30at one point or another
  • 01:31during my six weeks.
  • 01:33Like I said, renting a
  • 01:34car is is absolutely necessary.
  • 01:37I went to the Grand
  • 01:38Grand Canyon, Petrified National Forest.
  • 01:41Monument Valley is a quick,
  • 01:44hour and a half trip
  • 01:45away from Chinle.
  • 01:47Arches National Park up in
  • 01:49Utah, Canyonlands, Bryce Canyon, Zion,
  • 01:52Mesa
  • 01:53Verde. I mean, there's just
  • 01:55so much to do. There's
  • 01:56really big cities out there,
  • 01:58Albuquerque, Phoenix,
  • 01:59Tucson, Santa Fe.
  • 02:02And then there's a couple
  • 02:03really awesome day trips from
  • 02:04Chinle as well.
  • 02:07These are some pictures
  • 02:08of places I traveled to.
  • 02:10Shiprock is in the upper
  • 02:12left hand corner. It's a
  • 02:13town in Navajo Nation, very
  • 02:15underserved, but very, very pretty.
  • 02:18Mesa Verde, top right, middle
  • 02:20is Grand Canyon.
  • 02:22Chinle Canyon is on the
  • 02:23bottom left, and then Phoenix
  • 02:25is on the bottom right.
  • 02:28Top left is, Dead Horse
  • 02:31State Park. That was actually
  • 02:32my favorite.
  • 02:34Top right is Arches National
  • 02:35Park. Below that is Sedona,
  • 02:38and then bottom left is
  • 02:40this meteor impact site, which
  • 02:42I thought was pretty cool.
  • 02:45Horseshoe Bend,
  • 02:46from left to right is,
  • 02:48yeah, Horseshoe Bend in Arizona.
  • 02:51There is Antelope Canyon,
  • 02:54Zion National Park, and then
  • 02:56Bryce Canyon. And I did
  • 02:57a very long trek
  • 02:59in, like, three feet of
  • 03:00snow.
  • 03:03This is a natural arch,
  • 03:05which is located
  • 03:07right in Chinle pretty much,
  • 03:10on the top of this
  • 03:11really beautiful mesa.
  • 03:12It's very quiet. It's a
  • 03:14great place to go and
  • 03:15have a think.
  • 03:19So this is Navajo Nation.
  • 03:21If you've never seen a
  • 03:22map of it,
  • 03:23like I said, Arizona
  • 03:25to the e to the
  • 03:26west,
  • 03:27New Mexico to the east.
  • 03:28Above it is Utah and
  • 03:30Colorado.
  • 03:31It's broken up into seven
  • 03:32different districts. Chindley is in
  • 03:34the dead center of it.
  • 03:36And interestingly enough, Navajo Nation
  • 03:39surrounds the Hopi reservation,
  • 03:42which you see kind of
  • 03:43in there.
  • 03:47Some stats on,
  • 03:49Navajo Nation. It's the largest
  • 03:51Native American reservation in the
  • 03:53states. It's got a hundred
  • 03:54and sixty five thousand people
  • 03:55living on the reservation.
  • 03:57It's broken up into a
  • 03:58hundred and ten chapters. It's
  • 04:00got delegates,
  • 04:01a president,
  • 04:02so it's got representation.
  • 04:06Indian health services is what's,
  • 04:08supplies the health care to
  • 04:10the natives.
  • 04:12It's owned and operated by
  • 04:13the US US Department of
  • 04:15Health and Human Services,
  • 04:17started way back in the
  • 04:18nineteenth century,
  • 04:19in the Department of War.
  • 04:21It's located in thirty seven
  • 04:23different states. It serves two
  • 04:25point two million people.
  • 04:28It's got twenty six hospitals,
  • 04:31many facilities, and employs
  • 04:33some seven hundred physicians, twenty
  • 04:35six hundred nurses. So this
  • 04:36is a big, big organization
  • 04:38that you get to work
  • 04:39with.
  • 04:41So I just wanted to
  • 04:42throw this in there. During
  • 04:44my second year, I actually
  • 04:45went to Crown Point,
  • 04:47which is a smaller town,
  • 04:49in New Mexico
  • 04:51on Navajo reservation or Navajo
  • 04:53Nation reservation,
  • 04:55a much more rural sites.
  • 04:58It serves around twenty thousand
  • 04:59people. It has a twenty
  • 05:01bed hospital, four inpatient beds,
  • 05:04and it has,
  • 05:05for greater than fourteen thousand
  • 05:06emergency room visits. So for
  • 05:08such a small hospital, it's
  • 05:09pretty busy in the emergency
  • 05:11room where you actually see
  • 05:12a lot of, medicine going
  • 05:14down.
  • 05:16Where
  • 05:17I went last year, is
  • 05:19Chinle,
  • 05:21a much, much bigger town.
  • 05:23I'd say it's probably one
  • 05:24of the largest towns on
  • 05:26Navajo Nation.
  • 05:27It's got a population of
  • 05:29forty two hundred, a median
  • 05:31income,
  • 05:32median household income of thirty
  • 05:34thousand. So very impoverished population.
  • 05:37Chinle Hospital has an encatchment
  • 05:39area of thirty seven thousand
  • 05:40people. It's a sixteen bed
  • 05:42hospital.
  • 05:43It has outpatient, inpatient primary
  • 05:45care,
  • 05:46an adult ICU, general surgery,
  • 05:50obstetrics,
  • 05:51and a very busy emergency
  • 05:52room.
  • 05:54This is a map of
  • 05:55the campus.
  • 05:57The star to the left
  • 05:58is, that house that I
  • 06:00showed you in the beginning
  • 06:01where I lived.
  • 06:02The bottom star is the
  • 06:03hospital. So it's just a
  • 06:04very quick walk across the
  • 06:06parking lot, and you're there.
  • 06:08It's nice to kinda be
  • 06:09on the campus.
  • 06:15Okay. So my rotations.
  • 06:17I focused,
  • 06:19in outpatient primary care. So
  • 06:20I worked with the internal
  • 06:21medicine,
  • 06:22service, family medicine, and women's
  • 06:24health care.
  • 06:26I spent a good bit
  • 06:27of time in the emergency
  • 06:28room. I rode with EMS.
  • 06:31I
  • 06:33had some talks with the
  • 06:34native medicine person.
  • 06:36I worked with the diabetes
  • 06:38health coach team,
  • 06:39spent some time on the
  • 06:40inpatient wards, and even worked
  • 06:42in the fracture clinic. But
  • 06:43there's many other services that
  • 06:45that you can participate in.
  • 06:47There's a nursing home. There's
  • 06:48some psychiatry.
  • 06:50There's a mobile health unit
  • 06:52that goes to the far
  • 06:54corners of of,
  • 06:55of Chinle.
  • 06:58Typical outpatient encounter, because like
  • 07:00I said, I spent a
  • 07:01lot of time outpatient.
  • 07:02You get to rotate with
  • 07:03around
  • 07:05ten different providers, I wanna
  • 07:06say.
  • 07:07All of them have very
  • 07:09unique and awesome perspective,
  • 07:12and bring something different to
  • 07:14the table. I really enjoyed
  • 07:16working with, each of the
  • 07:17providers.
  • 07:18But you see around ten
  • 07:19patients in a half day,
  • 07:21a lot of established patients.
  • 07:23So it's neat to see
  • 07:24the relationship that the providers
  • 07:25have formed with the patients.
  • 07:27Quite a few ED follow
  • 07:28ups as well. The nurses
  • 07:30will triage the patients. They
  • 07:32will address all of the
  • 07:33health care maintenance stuff, so
  • 07:34you don't have to really
  • 07:35do a lot with that.
  • 07:37There is a diabetes health
  • 07:38coach that will come in
  • 07:39and talk with the patient,
  • 07:40and then they'll provide,
  • 07:42some analysis.
  • 07:44And then you go in,
  • 07:45you talk to the patient,
  • 07:47refer them to a large
  • 07:49network of facilities in Arizona
  • 07:51and New Mexico if indicated.
  • 07:55Diabetes health coaches will then
  • 07:56go back in,
  • 07:58and reinforce eight topics,
  • 08:00and then they're off to
  • 08:02care management, labs, and pharmacy,
  • 08:04which are all campus.
  • 08:09This is a a map
  • 08:11of,
  • 08:11where patients are going to.
  • 08:14So the star is Chinle.
  • 08:16You're setting patients all the
  • 08:17way to Flagstaff,
  • 08:19Gallup, Albuquerque,
  • 08:21even Phoenix.
  • 08:22So there is a long
  • 08:24distance for patients to travel
  • 08:26many times.
  • 08:28There are specialty clinics that
  • 08:29you also get to work
  • 08:30in. There's a diabetes team
  • 08:32like I had mentioned. There's
  • 08:33a bridge clinic,
  • 08:35and that focuses on substance
  • 08:36use. There's an STI express
  • 08:38clinic that's actually,
  • 08:40staffed and managed by pharmacists.
  • 08:42So they do testing, and
  • 08:43then they prescribe medicines.
  • 08:46There's a behavioral health clinic
  • 08:48and then a prenatal and
  • 08:49high risk pregnancy clinic.
  • 08:52There's a lot of similarities
  • 08:53and differences between those, the
  • 08:55two towns that I went
  • 08:56to.
  • 08:57Similarities,
  • 08:58pretty same acuity.
  • 09:01Patients are very sick,
  • 09:04very mission driven,
  • 09:05both facility and providers.
  • 09:08There's a lot of challenges
  • 09:09and barriers to health care,
  • 09:10a lot of disparities.
  • 09:12They are pretty similar across
  • 09:13the board.
  • 09:14Differences,
  • 09:15definitely resources. Chinle was heavily
  • 09:18resourced compared to Crown Point.
  • 09:20The primary care capacity at
  • 09:21Chinle is,
  • 09:23immense.
  • 09:24And then, like I said,
  • 09:25inpatient and and, critical care
  • 09:28capacity
  • 09:29at Crown Point was is
  • 09:30very
  • 09:32minimal. Some health care disparities
  • 09:34of the Navajos.
  • 09:36There are about one third
  • 09:37of Navajo homes are deficient
  • 09:39in plumbing and kitchen facilities.
  • 09:42About forty percent lack water
  • 09:44at their home. They have
  • 09:45to drive sometimes hours in
  • 09:47their pickup trucks and go
  • 09:48to a water dispensary station,
  • 09:50fill up bins of water,
  • 09:51and that's their water for
  • 09:52the week.
  • 09:54Fifty percent of the tribe
  • 09:55is unemployed. Life expectancy is
  • 09:57less than the rest of
  • 09:58the US.
  • 10:00Mortality rates are higher.
  • 10:02Twenty percent of adults suffer
  • 10:03from diabetes.
  • 10:04There's a huge population of,
  • 10:06Navajo that are obese or
  • 10:08overweight.
  • 10:10About seventy five percent are
  • 10:11considered food insecure.
  • 10:13It's a huge food desert.
  • 10:16Then diabetes
  • 10:18is extremely high on the
  • 10:20reservation.
  • 10:22And there's a large amount
  • 10:23of substance use.
  • 10:25Many people are using methamphetamine.
  • 10:28I would have patients tell
  • 10:29me that they would get
  • 10:31together with their family and
  • 10:32and, you know, the meth
  • 10:33would come out and they
  • 10:34would do meth together.
  • 10:36It's it's readily available, very
  • 10:38cheap.
  • 10:39Alcohol related illnesses
  • 10:41sky high on the reservation.
  • 10:44Patients would frequently come to
  • 10:45me and say they would
  • 10:47they were consuming hand sanitizer
  • 10:48because that is what they
  • 10:49would that's all they could
  • 10:50find to get intoxicated.
  • 10:53So a high amount of
  • 10:55liver disease and cirrhosis.
  • 11:00Yeah. There's,
  • 11:02a good amount of,
  • 11:05land contamination.
  • 11:07The the US, when they
  • 11:08were making,
  • 11:10atomic bombs, were,
  • 11:12mining uranium.
  • 11:14And they they there was
  • 11:16a ton of
  • 11:17contamination
  • 11:18in the rivers and the
  • 11:19streams and the land,
  • 11:22and it caused quite a
  • 11:23few health complications.
  • 11:26They
  • 11:27pretty much,
  • 11:29just
  • 11:31locked these sites up,
  • 11:33and they are now just
  • 11:34abandoned and contaminated land. And
  • 11:36there's really not a whole
  • 11:38lot of effort to clean
  • 11:39these sites up.
  • 11:43Some challenges exist.
  • 11:45There is
  • 11:47a good amount of mistrust
  • 11:48in the medical community.
  • 11:51There is an extremely impoverished
  • 11:54and limited resource
  • 11:55population with very low health
  • 11:57literacy.
  • 11:59Like I said, the median
  • 12:00income was less than thirty
  • 12:01thousand. This is per family,
  • 12:04and very limited access to
  • 12:06healthy foods
  • 12:07and quite a few high
  • 12:08access,
  • 12:10or quite a lot of
  • 12:11high access to fast foods.
  • 12:13I think
  • 12:14I was there for a
  • 12:16oh, for Valentine's Day, and
  • 12:17we went to the me
  • 12:18and the other resident went
  • 12:19to the Denny's in town.
  • 12:23So there is a Burger
  • 12:24King,
  • 12:24a Church's Chicken, and a
  • 12:26pizza edge, and that was
  • 12:27really it when it comes
  • 12:28to restaurants.
  • 12:30And there is really no
  • 12:31such thing as parks or
  • 12:32exercise facilities. A lot of
  • 12:34things were shut down,
  • 12:36because of COVID, and things
  • 12:38were just not opened up.
  • 12:42And that is,
  • 12:44a little bit of what
  • 12:46I experienced in Navajo Nation.
  • 12:48It is by far the
  • 12:49most amazing
  • 12:51thing I have done in
  • 12:53all of residency.
  • 12:54I think everybody else has
  • 12:56been saying the same thing.
  • 12:58If you're interested in primary
  • 13:00care, especially outpatient medicine,
  • 13:03this is the place to
  • 13:04go. It's a very underserved
  • 13:07population,
  • 13:08and you will gain,
  • 13:10some really
  • 13:12unique and valuable perspective
  • 13:14treating these types of, populations.