Navajo Healer, USU Alum Helps Battle COVID-19
By Vivian Mason
“I come from a long line of Navajo traditional healers (the Kinyaa’aanii [Towering House] clan), and I’m passionate about providing the best health care and public health training to Native American communities.”
Uniformed Services University alumnus, Phillip Smith, MD, MPH, was born on the Navajo Nation, the largest Native American reservation in the United States (an area of 27,000 square miles and a population of about 175,000 people). The entire Navajo Nation is very poor, very undersupported, and very under resourced. The lack of basic infrastructure support―e.g., running water, electricity, paved roads, conveniently located hospitals and grocery stores, etc.―has left this community uniquely vulnerable to the COVID-19 pandemic. Currently, the numbers of COVID-19 cases per capita surpass those of any geographical area in the country.
In 2012, after retiring as a U.S. Public Health Service (USPHS) commissioned officer from the Indian Health Service, Smith returned home to serve the Diné people. After a while, he was asked to stay and work permanently.
“I was really enjoying myself,” he said. He left behind a comfortable home in Kensington, Maryland, with every intention of returning in two years, but it’s been eight years and he is still caring for the Navajo people.
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| Dr. Phillip Smith [Image credit: Courtesy of Dr. Phillip Smith, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health] |
Smith’s USU education helps him provide top-notch healthcare. “I was in the graduate program at USU in the Preventive Medicine Department. I got my Master of Public Health degree and completed requirements to become board certified in Public Health and Preventive Medicine. Many of the Public Health Officers trained at USU. At that time, training at the University was state of the art. USU was very impressive in terms of its technology and expertise in population health and healthcare leadership, as well as training medical students,” he said. “Learning about infectious diseases and care of large populations that we might encounter during our years of practice was priceless. I felt uniquely prepared to meet the needs of my patients when I graduated. All of that knowledge has been immensely advantageous to help address the recent COVID-19 pandemic in our community.”
Over the years, Dr. Smith has worked in tribal hospitals and clinics on the Indian reservation. He also served as director of the Indian Health Service’s Office of Urban Indian Health Programs and later served as the chief medical officer for the Indian Health Service. He spent a large part of his career as a national Indian Health Service administrator before retiring.
“When I think about it, I’ve come a long way,” he recalls. “When I was a child, there weren’t very many opportunities growing up on a Navajo reservation. We were just resigned to working on the railroad or construction crew when we grew up.” There were no role models, and a turning point appeared in his life when he got the opportunity to go to public school in Gallup, New Mexico, instead of the Indian Boarding School. “If you lived within ten miles of where the bus stopped on the public road,” he explains, “you had to go to public school. My sister and I had to walk five miles to even get the bus to go to school, so we qualified to go.” From there, he worked hard, got good grades, and took advantage of programs, jobs, tutoring, and mentoring advantages that came his way.
Now that he’s working on the reservation as a primary care doctor, he typically sees about 120 patients per week for more than 10 hours a day. The Utah Navajo Health System is hundreds of miles away from the major hospitals going in any direction. It has been reported that some Native communities have been disproportionately affected by the COVID-19 epidemic, with an increased level of infection and mortality rates than the rest of the country. In the Navajo Nation, COVID-19 has been given the name Dikos Ntsaaigii, a Navajo term meaning “the cold that is enormous.”
“The people here need healthcare. We still see a lot of infectious diseases. Much of my past training is quite effective now because it allows me to treat many of these conditions and get patients to the tertiary care centers hundreds of miles away,” Smith said. “What has really helped us is telehealth. We’re trying to keep people who are healthy outside and not have them come into the clinic where sick people are.”
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| COVID-19 testing in a parking lot. [Image credit: Courtesy of Dr. Phillip Smith, Utah Navajo Health System] |
Arrangements were made for the elderly and others at high risk to have their medications refilled by using community health workers to transport/take medications directly to their homes and leave them in a secure place to minimize direct contact. “We also have patients call and link up to Zoom rather than have them come to the clinic and wait in the pharmacy,” he said.
The Utah clinic had not used telemedicine regularly; it had primarily been used for occasional specialty care cases (e.g., neurology, nephrology, etc.). “However, with the pandemic,” Smith said, “we switched to take care of patients via telehealth. We addressed chronic conditions and acute health issues, but still see injuries in the clinic.” For serious and critical conditions, patients are triaged to tertiary care facilities. But, all in all, the clinic staff has been able to address a lot of the needed healthcare.
“We’re still seeing a lot of common ailments. There’s also a high prevalence of underlying conditions, such as diabetes, obesity, asthma, high blood pressure, heart disease, lung disease, renal disease, and chronic pain. So, we do Family Medicine, Internal Medicine, OB/GYN, Pediatrics, etc. So far, on the Navajo Nation, we’ve had about 13,400 cases of COVID-19 and 600 deaths. About 85% of those deaths were among our elderly and that seems to be the problem area in this pandemic,: Smith said. In addition, because diabetes and obesity are prevalent, the impact of COVID-19 is also affecting individuals aged 30 to 40 years old. There’s also a shortage of testing and lack of adequate supplies.
“I haven’t performed any hospital care here because the distance to the hospital from where our remote clinic is located is quite far. If there are any requirements for respirators or specialty care, those patients are transported from our facility to the hospitals that are in the city. We’re really rural and remote. Our local hospital nearest to our community has only one respirator. So, COVID-19 cases requiring hospitalization have to be sent to Phoenix, Albuquerque, Grand Junction, or Salt Lake.” He points out further that, “We’ve been sending the veterans with COVID-19 to Salt Lake and Grand Junction VA hospitals. When they get to Grand Junction, many have been then sent to Denver. It’s been a great change for us with this pandemic.”
According to Smith, there have been major efforts made to get the Navajo people access to cell phones (via social services and home health workers working with phone companies, etc.). “This allows us to link up with people and let them know that the vaccine will be eventually available. However, until then, we remind people that they still need to take precautions and follow safety protocols.” There was a mandate issued by the President of the Navajo Nation that required everyone to wear masks, maintain social distancing, and shelter in place. He also issued a lockdown order and limited travel. All of this has helped curve the spread of the virus in the community.
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| Distribution of firewood, food, water, cleaning products, masks, and more to elderly and high-risk families to help fight COVID-19. Items were provided to 222 families. [Image credit: Courtesy of Navajo Nation] |
“We haven’t had the great secondary COVID-19 surge that you’ve seen in other places yet. Currently, it’s flatlined, but the virus is still around.” And, despite the big sky and wide open spaces, native people still tend to live together in multigenerational households and they enjoy socializing, thus making in-home self-quarantining very challenging. There have been situations in which COVID-19 infected entire families when it came into the Navajo communities.
The clinic has been helpful not only in making sure people get their medical services, but also in making sure that there’s sufficient water, access to food, availability of masks and sanitizer, internet access for school children, and other necessary supplies.
“On the Navajo reservation,” says Smith, “We’ve seen kindness from all kinds of people. For example, the churches have provided tremendous help and resources, such as delivering wood for stoves that heat our homes. Food and water have been donated and delivered to the Navajo Nation from various organizations. Also, the clinic has done a remarkable job helping supply other needed items.”
He believes that this has been one of the main positives throughout the pandemic. “The Navajos believe in helping our fellow man because it helps us know that things will be okay. And help has come in many forms. There has been a lot of unrest in the cities, but we haven’t seen it here in our rural community. People are still going on with their lives. That’s what’s so great about this country: people will jump in and help others when help is needed.”
And so will Dr. Phil Smith.
