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Painting the big picture on a Navajo reservation

[ Winter 2013 ]

Once upon a time, Anne Newland wanted to go to film school.

But because life unfolds with its own logic, she instead became a doctor with the federal Indian Health Service (IHS). And shaped by her experience working with Native Americans and the unique system that serves them, she realized the importance of focusing on population health. Today, Newland is working toward a master’s degree at HSPH.

The right questions

A Mongan Commonwealth Fund Fellow in Minority Health Policy, Newland, MPH ’13, has served as a physician at the Kayenta Health Center in Arizona for eight years, and as acting clinical director for the past three. A remote outpost with a downtown consisting of a small strip of stores, Kayenta is located about 25 miles south of Monument Valley, in the heart of gorgeously sculpted red-rock country. But the movie-set scenery belies deep public health problems.

Teen suicide, domestic violence, depression, isolation, substance abuse—all are pressing issues on the reservation. “We have therapists, psychiatrists, and substance abuse counselors at the health center, but services need to be greatly expanded,” Newland says.

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“Medical school and residency are where you learn to take care of individuals. An MPH helps prepare you to take care of communities.” Anne Newland, MPH ’13

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In particular, the seriously mentally ill—the patients Newland describes as “train wrecks about to happen”— need better support. With no involuntary commitment laws, tensions have erupted over whether such decisions lie with the tribal authority or the state. There’s also a chronic shortage of inpatient beds. All told, these problems have left mentally ill patients in limbo.

Newland recalls one woman with seizure disorder— “she was notorious for being difficult”—who would often wind up in the emergency room. Once, when Newland tried to stitch up a gash on the woman’s head, the woman threatened to hit her, so Newland backed off. Sadly, one day the woman suffered a seizure, collapsed near her wood stove, sustained serious burns over much of her body, and died shortly afterward.

“Just sad, sad, sad,” Newland says. She thinks better regional planning to arrange hospital admissions could help alleviate such problems—and she hopes her degree in health policy and management will help her develop systems that deliver more prompt and effective care.

Newland also wants to improve automobile safety. “I’d like to see more kids in car seats, not sitting in the front seat of a truck. And I’d like to see more people wear seat belts.” Adding more passing lanes to the region’s two-lane highways, she says, could help reduce car accidents.

And because many people on the reservation don’t have running water at home, she’d like to improve access to monitored water—because unmonitored wells and springs are more likely to be contaminated.

A larger, more complex issue is possible chronic uranium exposure from contamination left in the wake of mining conducted between the 1940s and the 1980s. The radioactive ore was sought for atomic weapons across some 27,000 square miles of Navajo lands in the Four Corners area—including the Skyline Mine about 25 miles from Kayenta—and many Navajo either worked as miners or lived and raised their families near the mines and processing mills. Newland hopes her public health training will help her better understand epidemiologic research around this issue—and perhaps someday conduct her own.

Building compassion

Though Newland is enthusiastic about studying at HSPH, she admits it was hard to leave Kayenta and her daily interactions with patients to pursue her studies.

“I love my patients,” she says. “What I enjoy most about being a primary-care physician is that I get to establish deep, long-term relationships. Navajo people are reserved; they don’t let you in easily. But they have a great sense of humor and, in the right moments, they really let you in.”

She adds: “When you are able to know people and help them through their health struggles, it builds compassion. Life is really, really hard sometimes, and when your health is affected, you can lose your equilibrium. In primary care, you get to help people regain their peace of mind. Taking that walk with many patients has been a powerful emotional experience.”reservation

And while she is still a film devotee, adding an MPH to her MD will likely prove far more rewarding than the MFA she once contemplated. “Medical school and residency are where you learn to take care of individuals,” Newland says. “An MPH helps prepare you to take care of communities. My goal is to build skills to take back to a community that needs it.”

Karen Feldscher is a senior writer at HSPH.