Information Session for Yale/Stanford Global Health Scholars Program 2022 - Arizona

Transcript

• 00:00I went to to Chinle as part of the
• 00:04one of the Indian Health Service
• 00:07sites on the Navajo reservation
• 00:10and and just really loved it.
• 00:11It was definitely my my favorite
• 00:14experience of of residency.
• 00:16So just a little bit of background
• 00:17information, The Navajo Nation,
• 00:19it's actually the largest federally
• 00:21recognized land based tribe in the US
• 00:24It's about the size of West Virginia.
• 00:26They also I've also often heard the
• 00:28size of New England minus Maine.
• 00:31So pretty, pretty large area and a lot
• 00:35of people within the Navajo Nation,
• 00:38most of whom actually live on
• 00:40the reservation still.
• 00:42And just to the right here I
• 00:43have a a a whole Garn which
• 00:45is a traditional Navajo home.
• 00:47And this is just a model,
• 00:48not not typically how they look these days,
• 00:50but still built in that same style.
• 00:54The Navajo people call themselves the Denay,
• 00:56which literally translates to the people.
• 01:00It's a little different society than
• 01:02the than other parts of the US it's
• 01:05a matriarchal society meaning that
• 01:07inheritance things like sheep and land
• 01:10and everything are passed down through
• 01:13through the the woman's side of the
• 01:15family or the mom's side of the family.
• 01:17And they,
• 01:18they all live quite spread apart on
• 01:20which you'll become really familiar
• 01:21with if you rotate here within camps.
• 01:24So there's kind of family camps where
• 01:26there'll be an area with like grandma
• 01:28and grandpa up here and then all of their
• 01:32kids and grandkids live right nearby.
• 01:34But then it'll be miles between
• 01:36that place and another another,
• 01:38another area.
• 01:39But because of that,
• 01:41because they are so dispersed,
• 01:43there's several areas where there's
• 01:45just not running water or electricity
• 01:47or if there is they depend on on the
• 01:50solar power alone for their electricity.
• 01:52Not not a lot of infrastructure,
• 01:56the economy,
• 01:56a lot of people commute to actually
• 01:59get around to or to to work.
• 02:02But then sheep as historically a huge
• 02:06part of their economy has has obviously
• 02:08become less so over over the years.
• 02:10But it's still an important culture
• 02:13and historical aspect of their their
• 02:16society and their their government
• 02:18is not too dissimilar from ours.
• 02:20They're they're broken up into chapters
• 02:22and then have a tribal council and a
• 02:25president over the the Navajo Nation.
• 02:27So I I was specifically in Chinle
• 02:30which is a town of about four to 5000
• 02:33people and it's on a on a plateau.
• 02:35And so it was actually I went
• 02:37in the late winter,
• 02:38it was February and March and actually
• 02:40got snow I think two or three times.
• 02:42And and so it's not quite the
• 02:45like hot desert that you picture
• 02:47usually with Arizona here is just
• 02:50an aerial view of Chinley.
• 02:51And I'll just highlight
• 02:53here's where actually the,
• 02:55the Chinley service unit,
• 02:56the hospital and the clinics
• 02:57were located over here.
• 02:59Here's the rest of the town over here.
• 03:03And so the the health service
• 03:05unit itself actually served
• 03:06a quite large catchment area,
• 03:08about 40,000 people and had a a pretty robust
• 03:12amount of services that they could offer.
• 03:14So Pediatrics, family medicine,
• 03:16Women's Health, internal medicine,
• 03:18this didn't happen every week,
• 03:20but nephrology and dermatology also would
• 03:23come periodically and set up clinics there.
• 03:26I'll get into in a second.
• 03:27There's a fracture clinic which I I
• 03:29really loved and then their Ed had a
• 03:32six bed Ed for high acuity patients
• 03:34and then there was an attached urgent
• 03:37care for some of the lower acuity more yeah,
• 03:41like stitches or stitches removal
• 03:43that type of that type of care.
• 03:46The inpatient side was about 25 beds,
• 03:504 MCU beds.
• 03:51But interestingly they didn't have
• 03:53any hemodialysis capabilities
• 03:55or Cath lab capabilities.
• 03:57So a lot of times they'd have to go from
• 04:00the Ed and and be on a helicopter or
• 04:03a plane to be sent out to other other
• 04:05health centers that did offer those services.
• 04:09Some cases that I thought highlighted well,
• 04:11some of the experiences I had there,
• 04:13I really saw so much
• 04:15different type of pathology.
• 04:17But but one thing I would wanted
• 04:19to highlight is really excellent
• 04:20primary care that they have there.
• 04:22And so here's just one example
• 04:24of a patient I saw.
• 04:25She had an A1C of 8.4 coming
• 04:28for diabetes follow up.
• 04:30She had a continuous glucose monitor
• 04:32and what amazed me was the the monitor
• 04:35itself was kind of malfunctioning.
• 04:36So they just went,
• 04:37grabbed another one, brought it to her.
• 04:39You can imagine in our clinics how
• 04:41hard it is to get something like
• 04:42that for patients, takes weeks.
• 04:44And this patient was getting a
• 04:46replacement one right there for free.
• 04:48And it's because of the the services
• 04:50that that part of Indian health
• 04:52services that they can offer because
• 04:54diabetes is so prevalent there that
• 04:56there's just a lot of resources
• 04:58poured into treating diabetes.
• 05:00So she got her new glucose monitor.
• 05:02They printed off her whole report
• 05:04of the the past few weeks of her
• 05:06sugars went over that with her with
• 05:09the diabetes educator and they
• 05:11have a robust formulary.
• 05:12You know similar to Medicaid,
• 05:13can offer similar amounts of
• 05:16different different types of first
• 05:18line medications for diabetes.
• 05:19So if you're interested in
• 05:21getting better at diabetes care,
• 05:22this is a great place to to learn.
• 05:26Another case that I saw in the the
• 05:29inpatient side was a middle-aged man.
• 05:31He had acute poste articular arthritis,
• 05:34had a significant work up.
• 05:36They tapped the joint looking for
• 05:39for gout or septic arthritis and
• 05:42quite a large work up and it was
• 05:43cool getting to you know see that
• 05:46you know first hand and not not
• 05:48after they were boarding in the
• 05:49Ed for a certain amount of time.
• 05:51It was more of a fresh case that
• 05:53came up came up to us ended up being
• 05:56what was likely reactive arthritis.
• 05:58The other cool thing I'll mention
• 06:00here is the the inpatient doctors
• 06:02also staff the at the clinic.
• 06:04So they were able just to see
• 06:06him in clinic the next day and that
• 06:08continuity was preserved quite well.
• 06:11Fracture clinic which is
• 06:12I thought was super cool,
• 06:13it's actually staffed by some family
• 06:16medicine doctors and some Med PEDs
• 06:19doctors and they essentially have when
• 06:21you get there they'll have a a book
• 06:23on you know management of fractures
• 06:25for for primary care physicians.
• 06:27So I got to do things I never imagined
• 06:30I'd do an internal medicine residency
• 06:32like helping with casting of a forearm
• 06:35fracture and then managing something
• 06:38like a non displaced metatarsal fracture.
• 06:41You know, normally I would have just
• 06:43referred that patient directly to
• 06:45Ortho or sent them even to the Ed.
• 06:47But here they actually had some some
• 06:49education and resources to be able to
• 06:52take care for those patients themselves,
• 06:53which I thought was a really useful tool
• 06:56that I'll I'll certainly use in when I
• 06:58met a primary care doctor in the future.
• 07:01And then the Ed probably where I saw
• 07:04that the most pathology helped reduce
• 07:06a a dislocated shoulder had a case
• 07:09of severe metabolic acidosis that
• 07:12was concerning for toxic alcohol use
• 07:14given the frequency of of alcohol
• 07:16use disorder there.
• 07:17We had started from mepazole.
• 07:18So a lot of just really interesting
• 07:20cases and that are coming in fresh,
• 07:23right.
• 07:23They're not,
• 07:24they're not things that that have been
• 07:28like off in the inpatient side at
• 07:29some of our hospitals where they're,
• 07:31they're boarding in the Ed for some time.
• 07:36So I'm just going back to this map here.
• 07:39I'm just going to talk
• 07:40about where where I stayed.
• 07:41So kind of back here just behind the
• 07:43hospital, there's a row of houses where
• 07:45they they provided housing for us.
• 07:48And here's the house that I stayed
• 07:50in was really really well equipped,
• 07:52had furniture, multiple bathrooms,
• 07:54had a fully equipped kitchen.
• 07:57And then just behind the house
• 07:59probably a few minutes walk is
• 08:00this this beautiful Mesa up here.
• 08:02And you could look out and see the
• 08:04whole city and and look out into the
• 08:06Canyon de Che which is one of the
• 08:08the kind of highlights of of Chinle
• 08:10just about a 5 or 10 minute drive.
• 08:12And here's just one of the pictures
• 08:14that I took just really beautiful slot
• 08:17canyons and with with ruins from prior
• 08:21indigenous peoples that that lived there.
• 08:23So lots of fun things to go explore.
• 08:26Here's another picture of a arch that
• 08:28was about a 15 minute drive from
• 08:31from the house and the hospital.
• 08:32So they give you they give you
• 08:34time to go explore as well.
• 08:36But you're not missing out on on great
• 08:38pathology because you basically see
• 08:40see excellent cases every time you're
• 08:42you're in clinic or the hospital.
• 08:46So I I'll leave it at that.
• 08:48I I'm sorry I can't stay for the
• 08:49end for question and answers.
• 08:50I'm actually heading off to a job
• 08:52interview in in just a moment but
• 08:54I'll leave this up for a second.
• 08:55Here's my e-mail address
• 08:56or my cell phone number.
• 08:58I love talking about Chinle,
• 08:59so feel free to just just
• 09:01reach out to me anytime.