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Tuesday Jan 23, 2018

How a Rotation Far From Home Helped Me Appreciate Community

During my third year of medical school, my classmate Michael heard about a rotation at the Northern Navajo Medical Center in Shiprock, N.M. I could not pass up the opportunity to expand my medical knowledge while experiencing a new culture.

We applied one year in advance to ensure we had spots and were fortunate enough to secure two positions in the family medicine department. My excitement continued to grow as the months passed by.

My Saint Louis University School of Medicine classmate Michael Baltes, left, and I enjoy the sights during our rotation at the Northern Navajo Medical Center in Shiprock, N.M.

As we drove into New Mexico, I knew that I was in for an adventure unlike any I had experienced before. It was early evening when we rolled into Shiprock. The roads were quiet, with only a few cars in sight, and the sun was falling toward the horizon. We turned right off the main thoroughfare, seemingly headed into a landscape of nothingness except for the hospital and a few scattered buildings on the side of the road.

Pulling up to the medical center, I felt a jolt of excitement, as well as anxiety. I was so excited for this opportunity, but I was already feeling like an imposter in this quaint little town surrounded by vast, beautiful desert with mesas dotting the skyline. It was a long way from St. Louis and my concrete world of interweaving highways and big buildings.

Further reinforcing this mental isolation was the fact that the town has only 8,300 residents. The population is 96 percent Native American and only 1 percent white. How was I supposed to tend to individuals' medical concerns and social needs when I had only read a few articles about their lives and culture? Furthermore, how was I supposed to build a trusting relationship with this group of people when I was only going to be in town for three weeks?

I did not have an epiphany about how to manage this internal conflict, so I defaulted to my basic learning instinct: I asked questions. During my time in the clinic, when the flow allowed, I talked with my patients about their Navajo traditions and beliefs and about life on the reservation. Outside of the clinic, Michael and I spent time traveling around the region, enjoying the rich histories of the numerous Native American tribes that inhabited and migrated through those lands. We explored ancient ruins, museums and sacred grounds. These conversations and adventures were informative and exciting, but the knowledge I gained will not stay with me forever. Slowly, over time, the faces of the people I met will fade in my memory. However, I will forever have a deeper appreciation for the power of community as a result of my experiences.

I had read an article by program director Heather Kovich, M.D.(www.nejm.org), about the transitory nature of physicians working at the Northern Navajo Medical Center, and I did not want to exacerbate the problems that stemmed from that situation. Much to my delight, I quickly was welcomed into a community of family physicians, internists and pediatricians who lived in the compound, a neighborhood of houses behind the hospital building. Besides working collaboratively in the hospital and clinic, they spent at least one night a week cooking out, and they enjoyed each other's company while also inviting visiting residents and medical students to join them. On clear nights, they would drive to the nearest mesa and cook on an open fire overlooking magnificent landscapes that changed colors under the setting sun. This eclectic group of individuals from across the country (and sometimes the world) found a home in Shiprock, whether it was for two years or 10. Their openness to strangers, knowing that people rarely become permanent residents in the community, was beautiful to me.

I noticed this same warmth and kindness from the patients I saw. Yes, many patients did ask me how long I was staying, and there was no way around their disappointment, but the conversation always ended with, "We hope you come back and work here."

They welcomed me immediately and encouraged me to learn more about their culture and lives. Along with experiencing this openness, I also witnessed the strong connections of the Navajo culture to living relatives and ancestors through the care of and attention to family members in the clinic and in local nursing home settings.

Ultimately, my experience on the Navajo reservation drastically changed my fourth year of medical school, especially how I approached residency interviews. First, I realized that I had lost touch with my medical school community and committed myself to reconnecting with classmates. Second, I began looking at interviews as glimpses of potential future communities where I would be shaping both my clinical skills and my social conscience. Suddenly the relationships of residents, faculty and staff became more important to me than the details of whether a program was urban or rural, or whether it was a single- versus a multiple-residency training site. Watching how everyone interacted on the interview day became just as important as any question I could ask about a program.

Throughout most of medical school, I focused on the patient-physician relationship and building skills that would enable me to thrive in that environment. However, my time in Shiprock helped illuminate for me the heart of family medicine, which does not lie solely in the physician-patient relationship. It is also the community of family doctors who support and encourage each other throughout their training and careers.

John Heafner, M.P.H., is the student member of the AAFP Board of Directors.

Posted at 03:00PM Jan 23, 2018 by John Heafner, M.P.H.

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