The Indian Health Service (IHS) and Brigham and Women’s Hospital (BWH) a teaching affiliate of Harvard Medical School are working on an Outreach Program to help American Indian/Alaska Native (AI/AN) remote communities receive specialty services. This Outreach program is important since AI/AN communities especially in the Navajo Nation are vastly underserved and impoverished.
The Navajo Nation is the largest tribe in the U.S. with 225,000 members and is based in Arizona, Utah, and New Mexico. Patients have to travel extremely long distances to obtain medical services and often experience cultural differences with their providers. The situation is dire because there is a chronic lack of primary care physicians and specialists available to provide timely care.
There is a five year shorter lifespan for the AI/AN population which has the highest prevalence of Type 2 diabetes in the world with the rate of cardiovascular disease increasing at a rate significantly higher than the rest of the U.S population. In addition, the communities have among the highest rates for substance abuse and dependence in the nation and have higher rates than all other Americans for tuberculosis, accidents, homicides, and suicides.
Since the Outreach program began, 25 BWH physicians have worked in partnership with the IHS representing numerous specialties including rheumatology, cardiology, dermatology, neonatology, neurology, and others. In addition to providing direct patient care, the volunteer physicians provide skills training and educational lectures for the IHS staff at each facility.
The IHS sites currently partnering with BWH include the Northern Navajo Medical Center known as “Shiprock” and the Gallup Indian Medical Center. The Shiprock Service Unit is the largest service unit within the Navajo Nation caring for approximately 45,000 AI/AN mostly Navajo patients. There are 75 physicians working at the unit averaging 400 visits per day with limited availability of on-site specialty services.
The Gallup Indian Medical Center located in New Mexico on the border of the Navajo Reservation cares for 40,00 AI/AN patients and serves as a referral center for many of the smaller health centers within even more remote areas of the Navajo reservation.
The program also includes a longitudinal component that is delivered through telemedicine technology. BWH physicians communicate with IHS clinical colleagues via video conferencing technology. The physicians are now able to conduct medical rounds and listen to challenging clinical cases presented by IHS physicians using the technology.
According to an article appearing in the IHS Office of Information Technology April 2011 newsletter, the first video conference was held November 2010 between the Northern Navajo Medical Center and BWH physicians from the Division of Rheumatology. The one hour conference was a coordinated effort between IHS technology support staff in Aberdeen and Shiprock working with IT staff at BWH.
Test calls were conducted prior to the actual video conference to ensure compatibility among all systems with conference bridge support provided by both Aberdeen and Boston video engineers. A second rheumatology video conference between Shiprock and BWH was held in February 2011 with a third video conference to be held in the spring and there are plans to expand the program to Gallup.