Navajo physician returns as surgeon general

By Amanda Schoenberg
Albuquerque, New Mexico (AP) March 2012

In November, Dr. Gayle DineChacon came home.

Her new life in the Navajo Nation’s capital, about 60 miles from her family home in Chinle, Ariz., marked the start of her two-year post as the tribe’s Surgeon General.

It is a temporary departure from her work as associate professor of family medicine at the University of New Mexico and as director of the school’s Center for Native American Health.

“This is coming home,” she says. “I really feel that I’m really working for the Nation, the people. This is the first time I’ve ever really felt like that.”

She is the second person to hold the job after Dr. Taylor McKenzie, the first Navajo to earn a medical degree, died in 2007.

As top medical officer, her goals are ambitious. She hopes to guide policy on health problems affecting Navajos, such as high rates of diabetes and injuries. She will also tackle systemic issues of self-determination and access to data facing the tribe.

DineChacon is working closely with Larry Curley, director of the Navajo Division of Health, to transform the division into a department of health with full public health functions. The federal Indian Health Services provides most direct medical care but the Nation should be responsible for its people’s public health needs, she says.

That means moving into the bureaucratic terrain of monitoring, evaluating and regulating public health. For example, the tribe has no oversight to ensure a dentist is licensed and provides quality care, she says.

“We won’t necessarily be assuming the authority of a licensing office. It’s more assuring that, `OK, do you have a license, let’s see the license,’ " she says.

Increasing oversight is just one part of the job. The big picture is about “exercising our inherent sovereign rights as a nation to control and direct our own health system for our people,” she says.

That prospect is at once challenging and fulfilling.

“It’s nation-building, basically,” she says.

Incorporating traditional beliefs and ways of life into how the tribe approaches public health and wellness is crucial. While many programs target diseases like diabetes among American Indians not every approach works for Navajos, she says.

DineChacon likes to quote Beverly Becenti-Pigman, chair of the Navajo Health and Human Resources Review Board, who says, “What we need are more expert Indians and less Indian experts.”

“I hope I fall in the first category,” DineChacon says. “And that’s what we need more of. Some of our own Indian people and that frame of mind to address the unique challenges for our people, especially today as many changes are happening in health care reform.”

Much of her work revolves around meeting stakeholders on all sides of Native health.

One February morning, DineChacon sat at a conference table talking about Native health needs with representatives of tribes from across the country. As she left for lunch she chatted with every colleague that crossed her path and pointed enthusiastically to a string of ponies gathered in the shade of a tree near Window Rock, the geological feature that gives the tribal capital its name.

Clearly, DineChacon is excited about her new life although she says she misses her students. She also drives to Albuquerque each weekend to see her husband, Lawrence Chacon, as well as her three children and one grandson.

Although she won’t have time to practice medicine full-time, she plans to start clinic hours at nearby Fort Defiance Indian Hospital. In addition to keeping up her clinical skills, it will help her see how patients and providers navigate the system, she says.

As Surgeon General, she also will continue to work on getting more Native students into medical professions. In April, she will visit Havana, Cuba, with Navajo Nation Vice President Rex Lee Jim to discuss the possibility of a program for Navajo students to study medicine in Cuba.

Once students become doctors, it is tough to recruit them back to the reservation, she says. Reasons include less pay, lack of infrastructure and a sense of disconnect from rural lifestyles after years in urban settings.

Not every student should feel obligated to return to the reservation, she adds. No matter where they live, more Native professionals means more options for all.

DineChacon also hopes to develop fellowships in health and tribal policy for Navajo students, a sort of fast-track to positions like hers.

Her experience in medical school, as the only Native student in her class at UNM, was sometimes difficult. She would like students today to understand Navajo perspectives on health, wellness and policy along with their Western education.

Dr. Arthur Kaufman, vice chancellor for community health at UNM and distinguished professor of Family and Community Medicine, has known DinÈChacon since she was a first-year medical student.

She brings a high level of cultural competency to her new job, he says. DinÈChacon has also developed a deep understanding of what makes communities healthy. Social determinants like good jobs, education and safety are major factors.

“That is something she is really an expert on and she brings that perspective to her job,” he says. “Having grown up in a community you see those social determinants every day.”

DineChacon’s career got an early start at home, which her parents filled with books. She remembers one that her father brought home when she was about 5 years old. It showed a clothed man and woman. On the next page, it showed them without clothes, then without skin and then their nervous system and internal organs. The last page showed their skeletons.

“That’s when I started to cry,” she says. “I cried so much that my Dad asked me what was wrong. I told him this scared me . He sat down and explained to me, `this is our body. God made this.”’

For someone who never attended college, he had a good grasp of anatomy and patiently explained it to her, she says. He told her she might become a doctor someday.

DineChacon had always loved math and science but it wasn’t until college that she thought seriously about becoming a doctor. Her family’s early encouragement planted the seed, she says.

After completing her residency, DineChacon spent four years working with Navajo patients in the Torreon area. She then returned to UNM as an assistant professor.

While at UNM she was medical director for Sandia Pueblo and for the Bernalillo County juvenile detention center, but never worked in a role that affects so many people, she says. The Navajo Nation includes more than 300,000 people.

Her first priority is helping the Nation become the “51st Medicaid state.” Navajo people now get Medicaid benefits from Arizona, New Mexico or Utah. Particularly for Four Corners residents who might live in Utah, have a post office box in Arizona and visit a New Mexico clinic, navigating state differences is a challenge.

“Those state lines really pose a problem for our people especially when it comes to health services,” she says. “Our people, we don’t see the state boundaries. Our land is bounded by the four sacred mountains.”

If the Nation assumed oversight over Medicaid, it would resolve some issues, she says. The Affordable Care Act includes a provision to study the idea.

Another priority is access to reliable health data. In many cases, the tribe cannot access current data on heart attacks, rates of diabetes or amputations of its people.

“We aren’t in control of our own numbers and statistics,” she says.

Her work involves breaking down barriers “built around us without any concern or any acknowledgment that we’ve been here thousands of years,” she says. “Trying to provide a seamless health system for our people is some of the challenge.”