“I Wanted To Do Anything That Could Help:” Offering Support to Caregivers in Indigenous Communities

August 1, 2022

The Navajo Nation covers 27,000 square miles of Utah, Arizona, and New Mexico. While beautiful, its rural setting brings a range of health disparities compounded by inadequate access to specialty clinical care.

Responding to these disparities, the Brigham and Women’s Physician Organization launched its collaboration with the Navajo Area Indian Health Service (IHS) in 2010.

“The needs within our Indigenous communities are striking,” said Ellen Bell, MBA, MPH, senior project manager for the outreach program.

“Our mission is to work alongside the IHS providers to help expand the range of health conditions they feel comfortable treating and thus increase the number of patients living on the reservation receiving care not previously available.”

McLean Hospital was invited to join this partnership at the onset of the COVID-19 pandemic due to the expanded need for behavioral health services and training.

“The Navajo Nation has the highest per capita loss of life and hospitalizations due to COVID-19 in the U.S. In this tight-knit community, in many instances, patients were staff, neighbors, and friends of those who cared for them,” explained Shelly F. Greenfield, MD, MPH, McLean’s chief academic officer.

“You can, therefore, imagine the level of trauma sustained by hospital providers and staff.”

Graffiti - Beware of COVID-18
The Navajo Nation has the highest per capita loss of life and hospitalizations due to COVID-19 in the U.S.

That collective trauma prompted Bell to reach out to Scott L. Rauch, MD, president and psychiatrist in chief at McLean.

“The [Shiprock] Northern Navajo Medical Center (NNMC) staff was severely impacted by COVID-19. There were four staff deaths, patient deaths, the loss of innumerable family members and esteemed elders, including the tribal medicine man, causing profound grief. It became clear that we needed to support the providers,” Bell said.

Beginning in March 2021, McLean mental health professionals, including Greenfield and volunteers like David Alperovitz, PsyD, made the trip to Shiprock to support their IHS colleagues, offering comfort in addition to training.

“I have a long-standing interest in Navajo culture and history—as a teenager, I grew up literally devouring Tony Hillerman novels,” Alperovitz explained.

“I wanted to do anything that could help support a population that has been subjected to injustice and mistreated for too long. I wasn’t prepared for what I encountered: there wasn’t a person I met who wasn’t touched by death. It was overwhelming. The first couple of nights, I cried walking home. At the same time, I was enormously impressed by the unbelievable resiliency of everyone I met.”

Watch Now: McLean staff share their experiences at the Northern Navajo Medical Center in this Grand Rounds lecture

McLean clinical staff provided what Greenfield described as peer support for NNMC clinical and administrative staff.

“There were few opportunities for NNMC staff to mourn losses or talk confidentially to any mental health provider because of the lack of available mental health services,” she said. “It can be helpful to talk with, and receive support from, somebody outside of your community.”

The McLean volunteers also provided education, including grand rounds lectures and trainings, and staffed a resource table in the hospital atrium with mental health information.

Twenty-four clinicians, including one from Massachusetts General Hospital, made the trip, and Alperovitz returned for a second week at another hospital in Chinle.

“I can’t say enough about the remarkable people who work at NNMC. The opportunity to provide support and contribute in this way to this community is truly an unbelievable privilege,” Greenfield said.

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