This month, I have been working in Shiprock, New Mexico on the Navajo reservation. I could spend years absorbing the grace and beauty of the land and its people, and I would still have much to learn. Here’s what I’ve observed in my humbling time here. (thread 1/)

Navajo Nation (Diné Bikéyah) has been hit hard by COVID. At Northern Navajo Medical Center, the Med/Surg Wing is a COVID unit, with non COVID pts housed in the Peds ward. PACU is spillover. Clinic is all walk-in so providers can focus on inpatient. Most of my admits are COVID. 2/

Every single member of the community has been affected by COVID. Although the sparse density of Navajo Nation seems like an ideal situation for social distancing, in reality, human connections are necessary for survival. 3/

About >25% of residents don’t have electricity, 35% don’t have running water, and >50% don’t have broadband internet. Families rely on each other for food, childcare, transportation, and other resources. They don’t have the luxury to self-quarantine. And so the virus spreads. 4/

Thus, everyone knows at least one family member, neighbor or friend who has died. Husbands and wives are admitted within days of each other, often sharing the same hospital room. It’s heartbreaking when one of the pair takes a turn for the worse. 5/

Existing struggles of alcohol abuse, drug abuse, and domestic violence are amplified. Many have lost work during the pandemic. I hear these stories from patients every day. The Nation is suffering. Other tribal communities are experiencing similar hardships. 6/

That being said, the community holds strong to science, and there’s been an outpouring of support and mobilization. Mass vaccination efforts are underway, and I had the privilege of helping vaccinate Navajo elders. 7/

When I vaccinated a 94 yo grandma, I imagined what she’s witnessed in her lifetime. I felt a strong urge to protect her with all my might. I hope a 0.3cc dose of mRNA will be enough. Some leave with tears in their eyes, saying, “Bless you” over and over. They’ve seen so much. 8/

Volunteers pour in from all over the country- Navy nurses who staff the PACU, anesthesiologists who thread lines and intubate, contact tracers who carefully track the virus, retired nurses who make calls to COVID patients dc’d on O2 and remind people of their 2nd vaccine appt. 9/

The local healthcare workers are forces of nature. I marvel at the creativity and grit they’ve shown in the face of devastation and uncertainty. A drive through car clinic. Mass vaccine efforts. Education. They are astonishing, fierce advocates for the community they love. 10/

My supervisor, @uwfmres/ @uwfm alumni Dr. Heather Kovich wrote a beautiful piece for @NEJM back in April. I would highly recommend reading all of her Perspective pieces about working on Navajo Nation. 11/ https://www.nejm.org/doi/full/10.1056/NEJMp2012114

This brings me back to my thread from August about the steadfast resilience of rural providers and the importance of closing health disparities in rural areas. 12/ https://twitter.com/jesslumd/status/1295571736042172416

I’m grateful to be a guest in this vibrant community. Follow these incredible people to learn more about Navajo Nation. Amplify the voices of Indigenous writers, doctors, artists, and more. /end

@Schischillyy, photojournalist
@ABecenti, journalist at @navajotimes