Introduction to the Global Health Scholars Program - Arizona

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.