Residency Rotation With Navajo Patients Helps Shape Career Paths

Residency Rotation With Navajo Patients Helps Shape Career Paths

By Daniel Solomon, MD (2010) and Sonja Solomon, MD (2010)

In August 2012, we were fortunate to spend several weeks at the Gallup Indian Medical Center in Gallup, New Mexico. The experience was truly a highlight of our residency. Our clinical work was divided between the primary care clinic, infectious disease clinic, and inpatient wards. We were precepted by an inspiring cadre of Brigham and Women’s Hospital (BWH) alumni who are full-time faculty at the Indian Health Service including Jon Iralu, MD (intern class of 1987), Maricruz Merino, MD (intern class of 2007), and Sonya Shin, MD, MPH (intern class of 1998), all of whom were outstanding teachers and generous mentors to us.

In the space of several short weeks we encountered patients with diseases that we would rarely or never see in Boston including hantavirus, genitourinary tuberculosis, and coccidiomycosis. But what impressed us most was the scope and severity of the chronic diseases facing the Navajo population, and the way in which the response to these diseases must be shaped by an understanding of health beliefs, cultural practices, history, language, and geography.

Perhaps themost powerfulaspect of our rotation was the chance to shadow the Navajo community health representatives (CHRs) who provide one-on-one outreach to patients on the reservation through the Community Outreach and Patient Empowerment (COPE) program lead by Dr. Shin. Meeting patients in their homes and traveling the physical distance that separates them from the nearest health center (not to mention the nearest grocery store) made visible many social determinants of health, and witnessing the individualized support provided by the CHRs highlighted some possible solutions.

Our rotation in Gallup would not have been possible without the generous support of the BWH residency program, and our experiences there undoubtedly influenced our career paths. Daniel’s experience with HIV patients on the reservation helped to guide his decision to pursue a fellowship in Infectious Diseases, and he is now the BWH HIV fellow. Sonja is a primary care doctor at BWH and a recipient of a Primary Care Clinician-Innovator Fellowship to improve primary care delivery.