health facts about native americans

American Indians and Alaska Natives have the highest prevalence of type 2 diabetes in the world. The incidence is increasing in these two groups faster than in any other ethnic population. Cardiovascular disease is the leading cause of mortality among Native Americans, with a rising rate that is significantly higher than the rest of the U.S. general population. Rates of substance dependence and abuse among people 12 and older is highest among American Indians and Alaska Natives, and rates of overall illicit drug, alcohol, and binge alcohol use are among the highest in the nation. American Indians and Alaska Natives die at higher rates than all other Americans from alcoholism, tuberculosis, diabetes, accidents, homicide, and suicide.

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BRIGHAM AND WOMENS OUTREACH PROGRAM Indian Health Service

increasing access, improving care

bwh doctors volunteer at indian health service hospitals
o phone. No running water. A lack of healthy food. Two hours to travel for healthcare services. Living situations comparable to those found in a third-world country. These are the conditions that many Native Americans face every day.

BY jennifer B. wells

Phyllis Jen, MD, and Howard Hiatt, MD, visit a patient at his home on the Shiprock reservation.

Their poverty hurts. Native Americans die at higher rates than other Americans from alcoholism, tuberculosis, diabetes, accidents, homicide, and suicide. They have limited access to preventive services, including cancer screening, immunizations, and management of chronic diseases such as diabetes and heart disease. Not surprisingly, their life expectancy is six years shorter than the general U.S. population. One of the biggest healthcare challenges for Native Americans is a lack of physicians. The Indian Health Service (IHS) reports a nearly 15-percent vacancy rate in essential clinic positions. In keeping with Brigham and Womens Hospitals (BWH) commitment to community health, Phyllis Jen, MD, of the Department of Medicine, with Howard Hiatt, MD, and Amy Judd, both of the Division of Global Health Equity, viewed the IHS physician shortage as an opportunity to care for patients and to teach clinicians. In spring 2007, the trio traveled to New Mexico to assess the healthcare needs at IHS hospitals in Gallup and Shiprock. As a result of the trip, they submitted a proposal to the BWH Physicians Council to support a physician volunteer outreach project. The IHS program appealed to the council because physicians from different specialties could participate and make an impact in just a week or two, says Jessica Dudley, MD, chief medical officer for the BWH Physicians Organization and co-chair of the Physicians Council. In addition, the programs location in the United States made it easier to handle travel logistics and language issues. And, perhaps most important, the need was great.
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It is an incredible privilege to be able to carry on this important work.

I am excited about the high level of interest from our physicians and plan to continue developing a meaningful experience for BWH physicians, IHS clinicians and staff, and the Native American community.
THomAS SequIST, mD, mPH, clINIcAl DIrecTor for THe BWH INDIAN HeAlTH ServIce PHySIcIAN voluNTeer ProgrAm

Gallup Indian Medical Center, located in northwestern New Mexico in an urban area, is one of the largest IHS hospitals in the country. The hospital handles 250,000 outpatient visits, 2,800 operations, and more than 1,000 births annually. Gallup needs more physician coverage for both medical and surgical specialties. The Northern Navajo Medical Center in Shiprock, NM, is a 55-bed facility located on a Navajo reservation where approximately 45,000 Native Americans live. Clinicians with expertise in managing chronic diseases that plague the Native American population diabetes, heart disease, alcoholism, and depressionwould be especially helpful.

Stephanie Benally, a community health representative, provides direct care on a home visit to Maggie Smith in Oaksprings, AZ, on the Navajo Reservation.

Christian Arbelaez, MD, MPH, of the BWH Emergency Department, and the first physician to volunteer for the program, couldnt be more enthusiastic about his Gallup experience. The emergency department, the intensive care unit, and the wards dont look as different from the Brigham as you might think, Arbelaez says. The shortage of physicians and staff was most striking. Luckily, this is one area where we could help. I encourage physicians at all levels to donate a week or two and help by teaching and caring for patients. Assessing the needs and developing a plan for collaboration were the goals of the Shiprock visit of Sarah Feldman, MD, and Michael Muto, MD, of the BWH Division of Gynecologic Oncology. Shiprock physicians wanted more training in minimally invasive gynecology surgery, says Feldman. Yet with such a low volume of surgery cases, it is nearly impossible for them to

Christian Arbelaez, MD, MPH, BWH emergency medicine physician who volunteered at Gallup Indian Medical Center

practice these skills. Thus, we invited John Heusinkveld, MD, the chair of Obstetrics and Gynecology at Shiprock, to the Brigham to observe our colleagues in action. John may see 11 surgery cases a year, while some of our doctors handle 11 a day. In the programs first year, more than a dozen BWH physicians from eight different specialties volunteered at one of the hospitals. As the program matures, BWH will look for creative ways to meet the needs of the IHS hospitalsusing e-mail consults, long-distance learning, and innovative technology, says Dudley. Our challenge is to provide sustainable support. We want our efforts to last beyond that volunteer week.

sequist to lead physician volunteer program

In October 2009, BWH named Thomas Sequist, MD, MPH, the clinical director for its Indian Health Service Physician Volunteer Program. Sequist is an assistant professor of medicine and healthcare

Phyllis Jen, MD
(August 13, 1948April 21, 2009)

The entire Brigham and Womens Hospital community mourned the loss of Phyllis Jen, MD, who passed away April 21, 2009, in a tragic accident. Jen was a pivotal member of the BWH family. Beginning as a resident at BWH, Jen later joined Brigham Internal Medicine Associates in 1976 and became its medical director in 1982. She also served as the medical director of the Indian Health Service program, which she helped create. A common theme throughout Jens life was her ability to reach out personally and professionallyto her family, her patients, her colleagues, and underserved populations. During her career, she received many awards for patient care, teaching, and community service. Jens

impact on BWH is permanent, as evidenced by the heartfelt speeches given to the standing-room crowd at the July 16 memorial service to celebrate her life. Jen wholeheartedly embraced the mission of our teaching hospitaltraining the healthcare leaders of tomorrow and constantly trying to improve the quality of care. In this spirit, Brigham and Womens Hospital has established The Phyllis Jen, MD Memorial Fund to hold an annual lectureship focused on quality improvement, clinical innovations, and caring for underserved and other special populations. Gifts also support projects to improve the quality or safety of care. In addition, to help primary care grow and thrive as a medical specialty, the fund supports the Phyllis Jen Summer Scholars program for college students. for information about making a gift to The Phyllis Jen, mD memorial fund, contact Sarah van Blarcom, BWH Development office, at 617-424-4364 or svanblarcom@partners.org.

policy at Harvard Medical School and BWH, and a primary care physician at Harvard Vanguard Medical Associates. He has served for more than 15 years as director of the Four Directions Summer Research Program, which has given nearly 150 American Indian undergraduate students a research experience, career advice, and mentoring. Sequist, who is a Native American from the Taos Pueblo tribe in northern New Mexico, is committed to the advancement of Native Americans in medicine. It is an incredible privilege to be able to carry on this important work, he says. I am excited about the high level of interest from our physicians and plan to continue developing a meaningful experience for BWH physicians, IHS clinicians and staff, and the Native American community.

adapting pact to help native americans

Since 2003, BWHs Prevention and Access to Care and Treatment (PACT) program has used community health workers to improve the health of Bostons sickest HIV/AIDS patients. Now an international model, PACT has expanded its program to other chronic

diseases. Using the PACT approach, the BWH Division of Global Health Equity has teamed up with the Indian Health Service and the Navajo Nation Division of Healths Community Health Representative (CHR)/Outreach program to help tribal community health representatives manage chronic diseases of Native Americans in Gallup and Shiprock. Under the leadership of Sonya Shin, MD, MPH, a BWH physician who relocated to New Mexico, the project, which is supported by the Rx Foundation, is initially focusing on diabetes. Native Americans have the highest rate of type 2 diabetes in the world. Without careful management, high-risk diabetes patients are more likely to suffer from heart attacks, strokes, and renal failure. Support, technology, and training from BWH help community health representatives take on new responsibilities. Helping patients and family members to develop strategies to take their pills and make their appointments, they also coordinate with medical providers to deliver close follow-up care in the community. The program complements work underway by the Indian Health Services

Aaron Mann, MD, (right) is shown with a patient at the medical center in Shiprock. In 2008, when Mann was a junior resident at BWH, he spent a month at Shiprock as part of a residency elective. The experience clearly had an impact. A year later, when Mann completed his residency, he and his family moved to Shiprock, where he is a staff physician today.

medical system and will be adapted to other disorders, such as HIV/AIDS, hypertension, and heart disease. At stake is the opportunity for a healthier life for thousands of Native American patients. u
To support either of the BWH programs for the Indian Health Service, contact Nancy Sandman at the BWH Development office at 617-424-4345 or nsandman@partners.org.

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