Introduction to the Global Health Scholars Program - Arizona
November 06, 2024Information
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- 12313
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- 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.