Jessica Hoy, MD
Resident in Internal Medicine, BWH
PGY 2
Resident in Internal Medicine, BWH
PGY 2
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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