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Health care providers in the Navajo Nation, a community of more than a quarter of a million people, face a number of substantial barriers to delivering high quality care to the population they serve. Limited access to specialty services and a chronic understaffing of physicians are just a few of the issues that plague a community with a disproportionately high rate of diabetes and other chronic illnesses.
Since 2009, a BWH-based group of physicians has been working with Navajo community leaders in Gallup and Shiprock, New Mexico, to address these disparities. The Community Outreach and Patient Empowerment (COPE) Program is a formal collaboration between the Navajo Nation Community Health Representative Program, the Gallup, Shiprock, Fort Defiance and Chinle Service Units of the Indian Health Service, and BWH’s Division of Global Health Equity.
“COPE seeks to improve health outcomes among individuals with chronic disease,” said Sonya Shin, MD, MPH, who leads the program. “The work we’re doing is unique in that we’re not building a structure from the ground up. The Indian Health Service has already created a system of community health workers, so there is an existing team and all the ingredients are right there.”
COPE strives to provide the community health representatives with the training, support and resources to improve the health of patients with poorly-controlled chronic conditions and to prevent diabetes and other chronic conditions by working with high-risk families.
“Our goal in the Division of Global Health Equity is to make ourselves obsolete in the communities we help,” Shin said. “The community health representatives help us determine how best to deliver health education and to promote health.”
COPE also focuses on enhancing communications between community health representatives and care providers, as well as developing health promotion packages for patients. The Division of Global Health Equity hopes to expand its work in Native American health even further over the next five years, and collaboration with the Brigham and Women’s Outreach Program, which coordinates volunteer opportunities for BWH physicians at Gallup and Shiprock, will help as the program grows.
“Many of the BWH physicians who have volunteered have provided important input on building the COPE program,” said Shin. “Having the attendings come back for subsequent visits has been particularly useful in building community partnerships.”
As the COPE program grows, Shin hopes to address factors related to geographical and social isolation. “You can do all the promotion you want, but if a person is socially and geographically isolated, it’s really hard to make lifestyle changes,” she said.
The team has also identified two other areas on which to focus: access to healthy foods and careers in Native American health.
“Access to healthy foods was an obvious and urgent topic to us,” Shin said. “We’ve assembled a team of nutritionists, dieticians and others, and we plan to conduct a needs assessment of the barriers and resources to accessing healthy foods among the Navajo so we can build and implement an intervention.”
Shin also hopes to create opportunities for career development among health professionals interested in working in Native American health. “Without guidance and multi-tiered mentorship, it is sometimes challenging to be immersed in a remote community without additional resources and expertise,” she said. “There are many outstanding local and non-local providers interested in working with this population, and we want to support them in doing so.”