For the month of September, I embarked on the experience of a lifetime, living and working on the largest Native American reservation in the United States. Sprawled across the four corners region of Utah, Arizona, New Mexico and Colorado, the Navajo Reservation in Chinle, Arizona, encompasses an area as large as the entire state of West Virginia. Its population, however, is only about 300,000, making it extremely rural. To leave the reservation from Chinle, where I was living, required over 100 miles of travel in any direction. I would strongly recommend a rotation like this to other medical students, as I experienced cultural enrichment beyond compare. After my time there, I am interested in exploring further opportunities with the Indian Health Service, as many reservations are in desperate need of health care professionals.
Living on the Rez (as they call it), was a humbling and mind-opening experience. I had to get used to being the only white person around, which helped me gain perspective on what so many minorities experience every day. Resources were scarce: The town had a video rental store, laundromat, Burger King, a hotel, a gas station, and a grocery store – that was about it. Surprised by the number of stray dogs roaming the streets, I felt as if I were in a developing country. The land is also open range, so cows and horses roamed alongside, or on, the roads. The number of car accidents that occur on the Rez, either due to drunk driving or collisions with livestock, was significant, and is a huge cause of death for the younger population. Violence, whether domestic, substance abuse-related, or among neighboring tribes, was rampant. Perhaps my favorite part of life there was Navajo fried bread, eaten either by itself, as tacos, or as a burger bun. I purchased these, as well as other meals, regularly out of the back of trunks from people parked on the side of the road, after learning from many hospital colleagues that the food from these trucks is a favorite of the locals.
I was the only medical student at the hospital for my rotation, which was focused on primary care. My goal was to seek out any and all experiences that would help me better understand the breadth of primary care, so I worked in primary care clinics for pediatrics, internal, and family medicine. I also worked in subspecialty clinics such as rheumatology, dermatology, cardiology, fracture clinic, and nephrology, which were staffed by locums who were not regularly available. In addition, my time in Chinle allowed me to experience urgent care, the emergency department, optometry, nutrition, physical therapy, podiatry, and Native Medicine. It was an amazing opportunity to gain exposure to so many different aspects of medicine, many that I would never have the chance to see otherwise.
The medicine that I saw varied from routine metabolic syndrome to horrible chronic disease that was untreated for years. I was told that about 50 percent of the Navajo population is HLA-B27 positive, setting many people up for auto-immune conditions. Diabetes was everywhere, significantly more so than off of the reservation. Literally every patient either had diabetes or had a positive family history. Not just that, but every day someone’s A1c value was greater than 14, a marker for severe diabetes. This population has been hit hard by the Western diet, and they are in serious need of health education and primary care medicine.
I gained an invaluable understanding of the Navajo people and rural medicine while out in Chinle. It has inspired me to seek out future opportunities with the Indian Health Service, and remain involved in community outreach as a physician. I strongly recommend all medical students seek out a rotation like this in their fourth year. To apply for a position, contact recruiters through information available online about eight to 12 months in advance. There are IHS sites throughout the country, and they all desperately need health care professionals.