This story originally appeared on the Brigham and Women’s Global Health Hub blog.

Homes are isolated, with no running water and often no refrigeration. Heat is produced by a wood-burning stove in the kitchen. Landline phones are a rarity.  Access to preventive health services, such as cancer screening and immunizations, is often limited, and patients travel long distances to obtain medical care.

Despite these incredible barriers faced by the American Indian communities in New Mexico, physicians volunteering with the Brigham and Women’s Outreach Program and COPE are able to provide services and perform activities that positively impact the health and wellness of the Navajo people.

Margo Hudson, MD, made her first trip to Shiprock in 2009 and has since visited Gallup several times to improve the inpatient management of diabetes. There, along with Jamie Redgrave, MD, local physician Maricruz Merino, MD, (a former BWH resident) and Josh Valgardson, PharmD, they developed a program to assist the physicians with ordering insulin safely during hospitalization in patients usually managed on oral agents, a program that has involved hospital wide training (nursing, dietary etc). They just presented their findings of improved glucose values and improved physician acceptance to the American Diabetes Association Meeting in June in Chicago.

Through the Brigham and Women’s Outreach Program, Hudson and Redgrave came to collaborate with COPE, another global health initiative based in Gallup. COPE strives to strengthen the existing Community Health Representative Outreach program of the Navajo Nation to improve health outcomes of high risk patients with diabetes and other chronic conditions in American Indian communities.

Hudson and Redgrave collaborated with the BWH Division of Global Health Equity’s Sonya Shin, MD, a BWH-trained infectious disease specialist and director of the COPE Program, to improve the Gallup Indian Medical Center and affiliated communities’ diabetes outreach programs. These physicians have witnessed firsthand the poverty and poor health so common to American Indian communities that exists right here in the U.S.

“I have gone out with the community health representatives to see patients in their homes, which can be many miles from the outpatient clinic on dirt roads,” says Hudson.

The community health representatives speak to the patients in their Navajo language, making sure they understand how to take their medications and seeing if they have new problems. They also perform basic physical exams. Hudson felt that these home visits improved her understanding of the barriers to care and the tremendous work that the community health representatives perform. She believes that the COPE teaching tool developed by Shin for patient education can be adapted for many environments, especially an urban one like BWH.

While in Gallup, Hudson and Redgrave helped give educational updates to the community health representatives in new developments in management and diagnosis of diabetes, as well as physical diagnosis and history taking. Hudson also had the chance to look over the truly comprehensive low literacy teaching program for patients that Shin created, offering modest suggestions.

And Redgrave taught yoga classes to elders in the council houses, led other exercise classes, shared healthy food options and gave educational talks to the doctors in the IHS, noting that she “ found the patients we visited to be incredibly grateful and receptive to learning how to best take care of themselves, very gratifying to visit.”

Margo Hudson, MD, and Jamie Redgrave, MD, are among several BWH physicians who volunteer at Gallup Indian Medical Center and the Indian Health Service hospital in Shiprock through the Brigham and Women’s Outreach Program (BWOP) with Indian Health Service.  This centralized volunteer program is dedicated to providing specialty expertise in direct patient care and staff training in the Navajo Nation, where about 37 percent of people live in poverty.

Interested in learning more about PIH's work in Navajo Nation? Click here.

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