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

October 25, 2023

ID10902

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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.