INTERNATIONAL HEALTH
IN THE UNITED STATES
THOMAS G. ANDERSON, PhD, MD, MPH
RURAL NATIVE AMERICAN COMMUNITIES
•
Offer an excellent opportunity for an international health experience
•
Health care challenges virtually identical to those in developing countries
•
Living in these communities is a total cultural immersion experience
•
Most of these communities are in desperate need of quality medical care
•
Most Native American communities are geographically remote, but
•
Travel to these rural areas is relatively convenient and inexpensive
ONE NATIVE AMERICAN COMMUNITY
HAVASUPAI NATION
SUPAI, ARIZONA
HAVASUPAI NATION
•
Several hundred people with a unique shared history
•
Deeply imbedded cultural and religious traditions
•
Common language and ethnic descent
•
A well recognized cultural (national) identity
•
“People of the blue green water”
HAVASUPAI STATE
•
A formal government
•
Well defined sovereign borders
•
A national capitol – Supai Village
•
Democratically elected leadership
•
A flag and a song (national anthem)
SUPAI VILLAGE
•
The most remote settlement within the continental United States
•
Contains a church, elementary and middle school, café, lodge, general
store, post office, clinic, police station, and tribal offices
•
Homes widely dispersed over a few dozen square miles of canyon floor
•
Most residents are Havasupai; some Apache, Hualapai, and Caucasian
•
Alcohol, drugs, weapons not permitted, but …………
SUPAI CLINIC
Indian Health Service
•
Physician (locums tenens or IHS physician)
•
Resident nurse: Native American (non Havasupai)
•
Two basic exam rooms; one “trauma room”; one dental room
•
Pharmacy stocked by IHS clinic in Peach Springs, Arizona
•
Small lab (no chemistries or microbiology)
•
Minimal X-ray capability; No overnight holding facilities
SUPAI CLINIC SERVICES
•
Patients: newborn (3 days) through geriatrics (> 90 years)
•
Services: well child care, urgent care, preventive medicine
•
Services: chronic disease management (diabetes, HTN, obesity)
•
Medical care for tourists in an emergency only
•
Emergencies: major (frequently life threatening) trauma
•
Periodic dental team visits from Peach Springs IHS Clinic
•
Mental Health Services in aftermath of flooding disaster
HEALTH CARE CHALLENGES
•
Obstacles within the health care system
•
Limit access to medical care for vulnerable patient populations
•
Lead to inferior health care and clinical outcomes
•
Lead to racial, ethnic, and geographic disparities in health status
•
Offer opportunities to explore creative solutions to problems
HEALTH CARE CHALLENGES in SUPAI
GEOGRAPHIC
TRANSPORTATION
LINGUISTIC
CULTURAL
EDUCATIONAL
SOCIOECONOMIC
POLITICAL
PUBLIC HEALTH
MENTAL HEALTH
COMMUNICATIONS
GEOGRAPHIC CHALLENGES
•
Supai is the most remote village within the continental US
150 miles from Flagstaff; 200 miles from Las Vegas (airport)
•
Village accessible only by helicopter, horseback, or on foot
•
Patients walk to clinic from remote areas of the Grand Canyon
•
Limited access to specialty care, hospitals, and other referrals
•
Rural health profession shortage area
TRANSPORTATION PROBLEMS
•
Small Kawasaki Mule only emergency ground transportation
•
Patients too ill for clinic visits require house calls
•
Emergency transfer only available by helicopter
•
Medevac flights offered by competing companies
•
Night Medevac: narrow flight path to unlighted landing zone
•
MEDEVAC not always available in inclement weather
LINGUISTIC CHALLENGES
•
Havasupai widely spoken on the reservation
•
Tribal elders frequently refuse to speak English
•
Many adults do not speak English very well
•
Qualified / cooperative adult interpreters often unavailable
•
Children learn to speak English in the tribal school
•
Children often used as translators for family members
COMMUNICATION DIFFICULTIES
•
Cellular telephones not consistently reliable in the canyon
•
Land lines service more consistent but weather dependent
•
Handheld radios used for communication with remote sites
•
Tribal police available by radio if within range
•
Different frequencies monitored by various agencies
EDUCATIONAL LIMITATIONS
•
Supai Village has one primary and one middle school
•
Upper grade students (9th – 12th) sent out to boarding school
•
Most of these students return to Supai to just “hang out”
•
Many adults not educated past middle school level
•
Formal curriculum does not include health topics
•
Population has very poor understanding of health and disease
CULTURAL CHALLENGES
•
Patient beliefs and behaviors
•
Role of family members in decision-making
•
Fear of providing personal or medical information
•
Patient reliance on traditional healers and remedies
•
Physician expectations, beliefs, and behaviors
SOCIOECONOMIC FACTORS
Limited opportunity for meaningful employment
•
Overcrowding and unsanitary domestic conditions
•
Limited financial resources for non covered services
POLITICAL CHALLENGES
•
Lack of clinic support by the IHS due to non local politics
•
Failure of hospital based physicians to appreciate local conditions
•
Intense distrust of the HIS by tribal leaders
•
Resistance of tribal leaders in supporting health programs
•
Widespread distrust of modern medicine and technology
•
Animosity toward non Native American health care providers
MENTAL HEALTH ISSUES
•
Scarce Mental Health Resources and Services
•
Mental Illness: Depression, Anxiety, Schizophrenia
•
Major problems with domestic and child abuse
•
Epidemic levels of severe alcohol abuse
•
Substance abuse: Methamphetamines, cocaine, heroin, MJ
INTERNATIONAL HEALTH
IN THE UNITED STATES
Anyone seeking an international health experience should consider
a short term “rotation” in a rural Native American community
These communities offer an exciting, challenging, and rewarding
alternative for a truly memorable international health experience
Exposure to Native American health care systems can provide
valuable insight and experience in confronting the myriad
challenges frequently encountered in developing countries
Descargar

Document