Transformative Education
for Health Professionals

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Healthcare on the Navajo Reservation - a Navajo Physician Assistant

Revina Talker, MPAS, PA-C, Nadia Cobb, MS, PA-C

The Navajo Indian Tribe is the largest tribe in the United States.  The census also reports that between 35-45% of families on the reservation are below the poverty level.  With regard to educational achievements, American Indians are usually the lowest group to graduate from high school and even lower from college or graduate schools. Access to healthcare poses serious challenges. The following case is from one of the few Navajo speaking health care providers on the reservation. Revina Talker is a physician assistant.

Full project description: 

My role as a physician assistant who speaks Navajo gives me the opportunity to provide healthcare for all ages of our population.  I conduct well child exams, sports physical, splinting or laceration repair.  I manage chronic medical conditions like Type 2 diabetes, hypertension, osteoarthritis or rheumatoid arthritis, musculoskeletal pain and many other more conditions.  I work side by side with my supervising physician, Dr. Phil Smith, who is also Navajo and speaks Navajo well.  It is a very humbling opportunity to provide medical care to my people.  My language skill is a critical asset when speaking to my patients.  Our elderly patients are very appreciative when I speak to them in Navajo about their medical concerns.  It is a blessing and an honor to be a physician assistant and to have the privilege to provide medical care.  Our facilities are located in the Utah side of the Navajo Reservation and are found in Blanding, Montezuma Creek, Monument Valley and Navajo Mountain.  We have 16 providers (8 physicians, 6 physician assistants and 2 nurse practioners).

I attended the University of Utah Physician Assistant Program which is one of the oldest in the US, whose mission is to serve the rural and underserved populations with primary care.   In the second year of the program, I was able to return to my reservation on two separate rotations as well as an international rotation to Ghana.  All of these rotations solidified my desire to return to my people and provide essential medical services.  In Ghana, I was surprised about the similarities the Ghanaian people have with my culture.  Their huts in the countryside with wood piled outside reminded me of our hogans back home.  There was no electricity or water in places just like our reservation.  They were a very humble people and the medical assistants, which they are called but are essential physician assistants, were dedicated to their people.  The medical assistants touched my heart as their passion and desire to help their people was very much my desires as well. 

Given the economic status of most of our patient population, access to healthcare is limited.  Patients may not have enough gas money to get to the clinic or appointments to specialty providers.  Patients may not have transportation.  Education level of our older patients is limited due to their strong fluency in the Navajo language.  Our high unemployment rate, which is higher than the national level, speaks to lack of proper economic development.  All of these challenges contribute to high levels of alcoholism, drug abuse, suicide and domestic violence.  There are strides made in education as more of our high students are striving for a college education but they face many challenges that make it more difficult to achieve their goals.   

After brutal wars and conflicts with the U.S. Government, the Navajos, or Dine as they like to be called, were re-located onto a reservation that is found in three states: New Mexico, Arizona and Utah.  The land is said to be 27,000 square miles.  The population is estimated at 173,000 from the 2010 Census and the median income of families on the reservation is estimated at $10,000/year.  

One of my goals as a physician assistant is to provide opportunities for PA students at the University of Utah to experience rural medicine.  I serve as a preceptor for students for the past 4 years.  I believe this exposure to rural medicine and my reservation serves as a teaching opportunity for them to see firsthand the challenges we face and, thereby, understand their patients better.  I have met many people who do not understand how our rural location contributes to the challenges we encounter on the reservation.  I hope that I am able to teach these students a little about medicine and more about being compassionate and understanding.

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