Thursday, March 17, 2016

Social History

Jessica Hoy, MD
Resident in Internal Medicine, BWH

Recently in clinic at the Northern Navajo Medical Center in Shiprock, New Mexico, I saw a lovely 77 year old woman who was doing quite well. She had occasional urinary tract infections but she dealt with these at home and rarely came to clinic. A few months before I met her, she had been admitted with a kidney infection. 

As we discussed her UTIs, I suggested she try to come into clinic when she is feeling unwell so we could catch any infections before they got out of control. She smiled patiently at me and explained that her husband and daughter are disabled and none of them can drive: “So when I get sick, I walk to the highway and hitchhike to the doctor,” she said, coyly holding out her thumb.  It was hard to picture this little grandmother standing along the side of the highway awaiting a ride when her illness finally pushed her to seek medical care. But it was important for me to pay attention: this patient was teaching me a lesson about the social history of our patients at NNMC.

Like most medical practices, the lives of patients at NNMC vary broadly.  Some patients live several hours away, some live in cities, some live on the reservation.  But NNMC seems to have a special focus on understanding the social circumstances of the most marginalized and disadvantaged patients in the Navajo community.  For example, one doctor explained to me,  “sometimes we need to do things differently here; we may admit a little old lady with viral gastroenteritis so she doesn’t break a hip when she goes out to use her outhouse.”  Another time, as I was leaving the room of a patient that I was admitting, a nurse came in behind me and asked her own social history: “Do you have electricity in the home? Do you have heat? Do you have hot water?”  
Shiprock High School Girl's Basketball Game

It would be clichéd and naïve to say that this level of poverty on the reservation stunned me.   While my careful but common questions about my patients’ social history (eg. alcohol, tobacco and drug use) are important, they don’t begin to scratch the surface of the social circumstance of some of these patients.   

Getting to know the community has been one of the greatest privileges of being in Shiprock. From spending time with patients’ families to attending a high school basketball game, I have gotten a small glimpse of a world that is very different than the world of my patients in Boston. 

  This opportunity, to know a community deeper  and through fresh eyes, is why I wanted to come to Shiprock and what I will continue to carry with me as I return to Boston and the familiar community awaiting me there.

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