Indian Health Services in Chinle, AZ – Maria Martin

Written by Maria Martin, MD – PGY-2 Resident at Kaiser San Francisco OBGYN Residency Program while on a Global Health Rotation in Feb-March 2015 with Indian Health Services in Chinle, AZ.

Working at Chinle Comprehensive Health Care Facility was an amazing and enlightening experience. From the clinic to labor & delivery to the OR, I was able to experience the full spectrum of an OB-GYN generalist. The most fulfilling and interesting aspect of the experience were the patients…the Navajo.

Chinle Comprehensive Health Care Facility provides medical care to approximately 35,000 Navajo and plays a significant role in public health programs in the Navajo Nation. I got to experience working with this underserved population firsthand. On Labor & Delivery, women would come in with their partner and multiple family members to support them through the laboring process. Most women labored without any analgesia.  Patients had the option of intravenous pain medications and if they were close to delivery and desired stronger pain medication, they could receive an intra-thecal analgesia. Most of the patients traveled over 1-2 hours to get to the hospital and were well supported by their family and the hospital staff and chose no pain medication.

Working with midwives was also a wonderful and insightful experience.  Physicians and midwives would care for all laboring patients together and discuss management plans. It was great to experience and participate in the teamwork among the staff.  Moreover, it was interesting and insightful to work with midwives and see different laboring management processes. For example, midwives would utilize a variety of laboring positions to help patients cope in labor.

In clinic, I got to work in their high-risk Obstetric clinic seeing a variety of prenatal patients with diabetes, hyperthyroidism, or seizure disorder.  The patient population had a high rate of type 2 diabetes mellitus, obesity and gestational diabetes. The patients were often non-compliant with checking their blood sugars or bringing in their glucometer; thus, it would be critical to emphasize the importance of the impact on diabetes on their pregnancy and management of their insulin regimen. It was very useful to observe and learn how the physicians discussed with patients the importance of compliance. Furthermore, most of the patients were from low-income and impoverished communities and healthy dietary options were limited.

Other days of the week, I worked in the general gynecology clinic and saw patients for contraception discussions, well-women exams and various gynecologic complaints. The population has a high rate of STIs and discussion about safe sexual practices and contraception was important.

I also worked in their weekly breast clinic alongside General Surgeons and saw a variety of patients with varying breast complaints.  I was able to perform a number of breast exams and work-up breast masses with the General Surgeons. I also had great continuity when I got to perform surgery with a General Surgeon on a patient seen in breast clinic.

I spent one day with the Native Medicine Department and worked alongside a traditional healer. I witnessed the healer perform ceremonial services for patients, including inpatients and outpatients, adults and children. The Healer taught me about the Navajo culture including the coming-of-age ritual for young women, how various ailments are perceived, and how alcoholism has impacted the culture.

Besides my clinical work, I performed a number of surgeries including cesarean sections, abdominal hysterectomy, laparoscopic cystectomy and laparoscopic tubal ligation. I also performed some smaller procedures including cervical polypectomy and dilation & curettage. Some of the procedures were more challenging given the pandemic of obesity that has impacted this population.

The experience at Chinle Hospital was enlightening and amazing. Learning about the Navajo culture, taking care of an underserved, impoverished community and working alongside a variety of medical professionals (including midwives, OB-GYNs, and General Surgeons) was a unique experience as a resident physician that expanded my  cultural awareness, clinical experience, patient care and knowledge in OB-GYN.