Rural Health

     I am definitely getting a taste of rural health on my Navajo reservation.  First I would like to make it clear that each community is unique in itself and the issues that one community faces might not be the same issues the next community is facing.  However, it was very interesting to see that the research I was reading, with regards to my Native American population, does reflect what is actually going on in the clinical setting. It seems that the barriers to health care continue to be related to MUD, rural living conditions, and limited emergency services.  While I've had the pleasure of spending two whole days at the Pinon clinic in Arizona.  I was able to see what kind of services were offered to the greater community and beyond.  Mind you this is a clinic that offers multiple services like pharmacy services, public health, access to a traditional healer, pediatric care, nutrition, dental services, mental health, and women's health care services.  They have one ambulance that is also available if necessary.  The nearest tertiary center is 8 hours away in Phoenix, AZ and the nearest official emergency services is in Chinle, which is located 45 minutes east.  The road between Chinle and Pinon still is partially dirt road.  I was advised that when it rains or snows that road is not safe to drive on and you have a good chance of getting stuck in the mud.  Thankfully, my trip down this road was uneventful and safe.

       Like most Indian Health Services clinics, they try to offer all of these services in one location because they are located miles from a city.  I'm not saying Indian Health is perfect, but from what I saw here at this clinic, they are making an effort to bring health care to rural communities like Pinon.
                                        
                                             So what does this mean for pregnant women?

     For women who are high risk OB patients requiring the watchful eye of perinatal services, they will still receive some of their prenatal care here, but they will be referred to a perinatal group that is in Phoenix.  For anyone who has cared for women requiring perinatal care, you know what this means.  Usually these women will be seen by a perinatal provider twice a week and once by their primary OB doctor or midwife.  What this means for women in this community and surrounding communities is that twice a week they will most likely have to go to Phoenix, an 8 hour drive, to receive this care.  This clinic does have someone drive these women to Phoenix, but still this is hard on her and her family.
If a woman is in labor or has ruptured membranes she is checked and is encouraged to  have someone drive her to Chinle's labor & delivery unit.  Because they only have 1 ambulance they use it for more serious situations.  I am starting to see why one of the most common causes of maternal and fetal death is car accidents.
     Some of more prevalent infections these women face in this area are H. Pylori, Chlamydia and Gonorrhea.  For young children, pertussis, RSV, Flu, and upper respiratory infections seem to be causing the hospital rooms to fill up. However, I think it is also a problem in other areas outside of the Navajo reservation.
      I really was not trying to paint a gloom and doom picture, because really these issues that our reservation is facing are "Real Issues."  Indian health is complex and has many issues that are still being sorted out and addressed on a community level and a national one.  I feel strongly that government funding for Indian Health Services should be increased to more than the 50% they are getting right now.    I wonder who is advocating for the health and wellbeing of my tribe on a national level.  I wonder yet..if these issues can be fixed...and how do I fit into all of this?

Chinle

     I said my fare wells to my family yesterday afternoon.  My kids all gave me individual hugs and of course I told them each to help their dad while I was gone.  I hope that I can skype here so that I can at least see their little faces on a daily bases.  My husband promises to have them all well behaved by the time I return, but I think my kids have there own ideas.  Besides, I thought they were well behaved already?  Last night I spent most of my evening putting away all my stuff and getting groceries for the next couple of weeks.  

     Today was my first official day and so far it is going well. I spent the morning filling out all the government issue paperwork.  For anyone who has worked at an Indian Health Service Unit, know what I'm talking about.  My neighbor was nice enough to let me use his wi-fi access and his washer and dryer.  Which is a major bonus!  Internet is a resource people here don't all get to use.  So I'm thankful.  The neighbor I mentioned is a pharmacist and after chatting a little with him has told me it takes about 3 hours for medications to get filled..3 hours!  I guess that is rural health for you!  

      If I could describe Chinle,  I would say it is different shades of brown with tumble weeds all curled up at some of the western fences.  Mountains to the west and Canyon De Chelly National Monument to the East.  The main road coming into Chinle, goes to the heart of the town then T's off in two different directions. The Navajo term "Chinle" translates into "A Place Where Water Emerges from Canyon's Mouth"  While driving over here I was able to take in the beautiful sites and see farm animals grazing on the side of the road.  This also means I had to be careful not to run into one.  These photos don't do this place justice, because in the evening while the sun is setting, the mountains to the East turn bright red.

     I have to say it was nice hearing my native language spoken so freely in the hallways of the hospital.  Tomorrow is a new day and I get to meet more people.  Which I am thankful for, because I am already missing my family and all the sounds of my busy house.