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Despite looking out for cases of Hanta Pulmonary Syndrome, Bubonic Plague and rattlesnake bites, Christian Arbelaez, MD, MPH, was most startled by the number of injuries related to alcohol that Navajo patients presented with at an Indian Health Service hospital in New Mexico.
“So many of these traumas could have been prevented,” said Arbelaez, a BWH Emergency Medicine physician who volunteered one week this summer to treat patients and educate staff at Gallup Indian Medical Center, one of the largest Indian Health Service (IHS) hospitals in the U.S.
This spring, the Physicians’ Council chose to support a volunteer outreach project with IHS as part of the Brigham and Women’s Physician Outreach Program (BWOP). Phyllis Jen, MD, of the Department of Medicine, and Amy Judd and Howard Hiatt, MD, of the Division of Global Health Equity, submitted the project proposal, citing IHS’ clinical, administrative and educational needs at its hospitals in Gallup and Shiprock, New Mexico.
Jen, Judd and Hiatt gauged the health care needs in Gallup and Shiprock with an April 2007 trip. “The trip confirmed the urgency of the situation there,” Jen said. “The resource needs of these Americans are similar to the needs of people in many developing countries.”
Jessica Dudley, MD, chief medical officer for the BWPO and co-chair of the Physicians’ Council, said the Indian Health Service hospitals are places where many BWH physicians can make a difference. “For BWOP, we wanted a place where all interested physicians, no matter their specialty, could contribute for a week or two and make an impact,” she said.
According to the U.S. Department of Health and Human Services, American Indians and Alaska natives die at higher rates than all other Americans from alcoholism, as well as tuberculosis, diabetes, accidents, homicide and suicide. Native Americans have limited access to preventive services including cancer screening and immunizations, as well as chronic disease management, and their life expectancy is six years shorter than for the general U.S. population.
Both the 55-bed facility at Shiprock on the Navajo reservation and the 99-bed hospital at Gallup have adequate equipment, medication and supplies, but they are challenged by a shortage of staffing. The Indian Health Service reports a nearly 15 percent vacancy rate in essential clinical positions.
Arbelaez worked nine-hour shifts in the Gallup ED, enabling physicians there to spend time completing paperwork and other responsibilities that they simply cannot get to because there is no coverage. In addition, Arbelaez led on-the-job teaching and training for clinicians in Gallup, showing them newer technologies and techniques in use at BWH.
Navajo patients who receive care at these hospitals face many socioeconomic obstacles, including the great distances they must travel across vast New Mexico to receive care. About 37 percent of Navajos live below the poverty line, according to the U.S. Census Bureau. One third live in homes without plumbing, and two thirds do not have telephones. In New Mexico, nearby uranium mining leads to severe lung disease among many residents.
“We are greatly indebted to the Native American community,” said Hiatt. “Here is an opportunity for a small expression of our feelings.”
Contact Phyllis Jen if interested in volunteer opportunities with BWOP.